新疆维吾尔自治区克州地区三个民族急性心肌梗死患者的危险因素分析

Analysis of risk factors of acute myocardial infarction patients in three ethnic groups in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region

目的分析新疆维吾尔自治区克州地区三个民族(汉族、维吾尔族和柯尔克孜族)急性心肌梗死(AMI)患者的临床特征,评估影响患者死亡率的危险因素。方法收集2016年1月至2017年11月在新疆维吾尔自治区克州人民医院心血管内科明确诊断为AMI并行冠状动脉造影手术患者的临床数据进行回顾性研究,分析患者的人口统计学资料、民族、基础疾病、血液及生化指标、冠脉造影结果、预后情况等。再根据患者的临床转归分为生存组和死亡组,通过Logistic回归模型分析,确定影响三个民族AMI患者死亡率的危险因素。统计描述与数据分析均应用SPSS 22. 0统计分析软件完成。结果共纳入175例AMI患者,其中汉族41例、柯族47例、维族87例。25人最终死亡,汉族、柯族和维族的死亡率分别为12. 19%、17. 02%、13. 79%,三个民族死亡率无明显统计学差异。少数民族AMI患者饮酒率高于汉族患者,差异具有统计学意义(P <0. 05)。少数民族患者的收缩压(SBP)水平(P <0. 05)、舒张压(DBP)水平(P <0. 05)、血白细胞(WBC)计数(P <0. 001)、血中性粒细胞比值(NE%)(P <0. 05)和血清肌钙蛋白T(c TNT)水平(P <0. 001)高于汉族患者,而血红蛋白(HB)水平(P <0. 05)低于汉族患者。56. 10%的汉族AMI患者是多支冠脉血管病变,比例高于柯族和维族患者(P <0. 05)。Logistic回归分析发现血浆纤维蛋白原(FIB)水平(P <0. 05)、血红细胞(RBC)计数(P <0. 05)和发生多支冠脉血管病变(P <0. 05)是影响三个民族患者死亡率的危险因素。结论新疆维吾尔自治区克州地区少数民族患者和汉族患者在饮酒率和发生AMI时血压、WBC、NE%、HB、c TNT升高水平以及冠脉病变血管数方面存在差异性,血浆FIB水平、血RBC计数和发生多支冠脉血管病变是影响三个民族AMI死亡率的重要危险因素。

Objective To analyze the clinical characteristics profile of Han, Uygur and Khalkhas patients with acute myocardial infarction (AMI) and assess the risk factors affecting the mortality of patients in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. Methods A retrospective study was conducted among the patients diagnosed with AMI between January 2016 and November 2017 in the cardiovascular medicine department of Kizilsu Kirgiz Autonomous Prefecture People’s Hospital and performed coronary angiography. Data on demographic characteristics, ethnic groups, underlying diseases, blood and biochemical indices, coronary angiographic results and clinical outcome were collected. The differences of clinical characteristics among the AMI patients of the three ethnic groups were compared. According to the clinical outcome, the patients were divided into survivor and non-survivor groups. The risk factors affecting the mortality of patients of the three ethnic groups were identified by Logistic regression analysis. All statistical description and analysis was conducted by SPSS 22.0. Results 175 AMI patients were collected, of which the number of Han patients was 41, the number of Khalkhas patients was 47 and the number of Uygur patients was 87. 25 patients were dead finally. The mortality rate of Han, Khalkhas and Uygur patients was 12.19%, 17.02% and 13.79%, respectively. There was no statistical significance among the mortality rates of three ethnic groups. The drinking rate of ethnic minorities AMI patients was higher than that of Han group. The difference was statistically significant (P<0.05). As the same, the systolic blood pressure (SBP) levels (P<0.05), diastolic blood pressure (DBP) levels (P<0.05), white blood cell (WBC) count (P<0.001), neutrophilic granulocyte (NE)% (P<0.05) and serum cardiac troponin T (cTNT) levels (P<0.001) of ethnic minority patients were higher than that of Han group. But the hemoglobin (HB) levels of ethnic minority patients was lower than that of Han group (P<0.05). 56.10 % of Han AMI patients had combined with multi-vessel coronary artery infarction and the proportion was higher than that of ethnic minority patients (P<0.05). In Logistic regression analysis, the risk factors affecting mortality were the plasma fibrinogen (FIB) levels (P<0.05), red blood cell (RBC) count (P<0.05) and multi-vessel coronary artery infarction (P<0.05). Conclusion There were differences in drinking rate and increased levels of blood pressure, WBC, NE%, HB, cTNT and the number of vessels in coronary artery infarction at the time of AMI between ethnic minority groups and Han group in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. The plasma FIB levels, RBC count and multi-vessel coronary artery infarction were the important risk factors responsible for mortality of AMI in three ethnic groups.