冠心病的风险评估研究

Research progress on the risk assessment of coronary heart disease

目的研究冠心病(coronary heart disease,CHD)的风险因素、CHD风险评估的基本方法及发展趋势。方法查阅大量国内外文献,归纳总结CHD的风险因素及其风险评估的基本方法和发展趋势。结果 CHD风险评估参考的的主要传统风险因素有年龄、血压、胆固醇水平、糖尿病等。近年来新的风险因素的相继发现使得评估准确性提高。基于传统风险因素的CHD预测模型的典型代表是Framingham模型,后续出现的模型都是以此为基础建立并不断完善的,可有效预测短期患病风险,适用于那些风险因素累计到一定程度的中老年人。基于遗传因素的CHD评估模型可预测生命早期的患病风险,其中较公认的是CGR模型,但其没考虑家族史。将传统风险因素、遗传因素及家族史相结合的综合评估方法可能会提高CHD风险评估的准确性。结论 CHD风险评估模型正随着其风险因素的不断发现而不断完善。遗传因素评估模型和传统风险因素评估模型在不同生命阶段分别发挥着重要的指导作用。结合家族病史、遗传风险因素和传统风险因素的综合评估策略可能是未来CHD风险评估的最佳选择。

Aim To understand the risk factors （RFs） of coronary heart disease （CHD） and basic approaches and trend of CHD risk assessment （RA）. Methods A large number of peer literature were collected to summarize the RFs of CHD and basic methods and trend of CHD RA. Results The main conventional RFs for CHD include age, blood pressure, cholesterol levels, diabetes and so on. In recent years, the accuracy of RA for CHD has been in- creasing because of newly found RFs. The representative RA model of CHD based on conventional RFs is Framing- ham model, upon which subsequent improved RA models were established. These models can effectively predict the short-term risk and are suitable for middle-aged and elderly people whose RFs were accumulated to a certain de- gree. RA models of CHD based on genetic RFs are considered to be powerful throughout the lifespan, especially during the early stage of life. Combined genetic risk （CGR） model of Navigenics is generally accepted, but it didn＇ t consider family history as a RF. Comprehensive RA model considering conventional RFs, genetic RFs and family history may improve the accuracy of RA for CHD. Conclusion CHD RA models are continuously improved with more RFs being found. Genetic and conventional RA models play an important guiding role in different stages of life, respectively. In the future, the establishment of a new comprehensive RA model which may combine the con- ventional RFs with genetic RFs and family history will be a better proposal for RA.