多个危险因素对冠状动脉粥样硬化性心脏病的预测价值

The predictive value of coronary heart disease （CHD） risk factors in coronary atherosclerosis heart disease

目的探讨冠心病危险因素对冠状动脉粥样硬化性心脏病的预测价值。方法分析本院经冠状动脉造影检查（coronaryangiography，CAG）400例的临床病例，设计调查表并研究相关指标，依据冠脉造影结果将400例临床病例分为冠心病多支血管病变组、冠心病单支血管病变组以及非冠心病组，采用多因素Logistic回归分析来确定冠心病独立相关的危险因素，分析冠心病危险因素与冠状动脉病变的关系。结果冠心病组与非冠心病组血清胆固醇（Tc）、甘油三酯（TG）、高密度脂蛋白（HDL—C）、空腹血糖（FBG）、炎性细胞、颈动脉斑块、肱踝脉搏波传导速度（baPWV）、超敏C反应蛋白（Hs．CRP）比较差异有统计学意义（P〈0．05或P〈0．01）。多支血管病变患者年龄、BMI、高血压病、糖尿病、吸烟、颈动脉斑块、TG、TC、LDL-C、FBG、WBC、单核细胞绝对值（M）、中性粒细胞绝对值（N）、中性粒细胞／淋巴细胞（N／L）、baPWV、Hs-CRP高于单支血管病变患者，而血HDL—C、淋巴细胞绝对值（L）低于单支血管病变患者，差异有统计学意义（P〈0．05或P〈0．01）；两者左心室射血分数（LVEF％）差异无统计学意义（P〉0．05）。颈动脉斑块为冠心病最显著独立相关危险因、素（b=1．264，P〈0．01），其次依次为吸烟（b=1．204，P〈0．01）、HDL—C（b=1．104，P〈0．01）、TC（b：1．082，P〈0．01）、糖尿病病史（b=0．956，P〈0．01）、baPWV增高（b=0．741，P〈0．01）、WBC（b=0．721，P〈0．01）、高血压病（b=0．602，P〈0．01）、年龄（b=0．538，P〈0．01）、Hs—CRP（b=0．421，P〈0．01）。结论高血压、高血脂、糖尿病、吸烟、年龄、baPWV、炎性细胞、Hs—CRP、颈动脉斑块为冠心病的显著独立危险因素。

Objective To investigate the predictive value of cardiovascular risk factors in coronary atherosclerotic heart disease. Methods A total of 400 patients who underwent coronary angiography （CAG） in our hospital was divided into multiple vascular lesion group, single vascular lesions group, and non-CAD group according to the result of CAG and their clinical data were analyzed retrospectively. The correlation between cardiovascular risk factors and coronary artery lesions was analyzed, and the independent risk factor of CAD was screened by multi-factorial logistic regression analysis. Results There was signifi- cant difference in total cholesterol （TC）, triglycerides （TG）, high density lipoprotein cholesterol （HDL- C）, fasting blood glucose （FBG）, inflammatory cells, carotid artery plaque, brachial-ankle pulse wave ve- locity （baPWV）, high-sensitivity C-reactive protein （Hs-CRP） between the CAD group and the non-CAD group （ P 〈 0. 05 or P 〈 0. 01 ）. The number of coronary artery lesion branch was increased significantly when risk factors, such as age, body mass index（ BM1）, hypertension, diabetes mellitas, smoking, carotid artery plaque, TG, TC, low density lipoprotein cholesterol （LDL-C）, FBG, WBC, monocytes （M）, neutrophils （N）, neutrophils/lymphocytes （N/L）, baPWV, and Hs-CRP. Other risk factors including TC, HDL-C, L were decreased with a statistically significant difference （ P 〈 0. 05 ） . There was no significant relation among, and left ventricular ejection fraction （LVEF） %. The most significant risk factor was carotid artery plaque that was independently associated with coronary heart disease （ b = 1. 264, P 〈 0.01 ） , fol- lowed by smoking （b =1.204, P 〈0.01）, HDL-C （ b =1.104, P 〈0.01）, TC （ b =1.082, P 〈 0. 01） diabetes mellitus （ b =0. 956, P 〈0. 01）, baPWV increased （ b =0. 741, P 〈0. 01）, WBC （ b =0.721, P 〈0.01） , hypertension （ b =0.602, P 〈0.01） , the age （ b =0.538, P 〈0.01）, and Hs- CRP（ b = 0. 421, P 〈 0. 01 ）. Conclusions The results suggest that the hypertension, hyperlipidemia, smoking, age, baPWV, inflammatory cells, Hs-CRP, and carotid artery plaque was a significant independ- ent CHD risk factors.