早早发心肌梗死患者家族性高胆固醇血症的临床筛查与特点研究

Clinical Screening and Feature Study on Familial Hypercholesterolemia in Very Early Myocardial Infarction Patients

目的筛查早早发心肌梗死患者中的家族性高胆固醇血症(familial hypercholesterolemia,FH)发病率,FH各分型的临床特点,以及降脂治疗对FH的影响。方法连续入选1107例因首次心肌梗死行冠状动脉造影检查的患者。早早发心肌梗死的年龄标准定义为≤35岁。采用荷兰临床脂质网络标准进行FH分型。冠状动脉病变通过Gensini评分评估。结果无论是否经过降脂治疗,肯定的/很可能的FH组的低密度脂蛋白胆固醇水平均高于否认的FH组(P<0.001)。在肯定的/很可能的FH组中,FH患病率随着年龄的增加而降低(P<0.05)。与否认的FH组比较,肯定的/很可能的FH组年龄更小,接受降脂药物治疗,冠状动脉疾病家族史及极高危的比例更高,Gensini评分更高(P均<0.05)。在肯定的/很可能的FH组中,降脂药物治疗组的Gensini评分显著低于非降脂治疗组(P<0.05)。结论在早早发心肌梗死患者中肯定的/很可能的家族性高胆固醇血症者比例更高。尽早开始降脂治疗,无论是否达标,均可减轻冠脉病变。

Objective To screen the familial hypercholesterolemia(FH) of very early myocardial infarction patients, clinical features according to the diagnostic probability of FH phenotype, and lipid-lowering therapy to FH status. Methods Our study consecutively enrolled 1107 patients with coronary angiography for the first myocardial infarction. We designed to define very early myocardial infarction age as 35 years and younger. The clinical FH was diagnosed using the DLCN criteria. We evaluated the coronary severity of each patient by the Gensini score. Results The prevalence was lower as age increased in definite/probable FH(P <0.05). Compared to those unlikely FH, patients with definite/probable FH was younger, had higher rates of family history of lipid-lowering treatment, CAD, VHR and higher GS(P<0.05). In definite/probable FH, the GS was lower in patients with lipid-lowering treatment than those without lipid-lowering treatment(P<0.05). Conclusions The rates of definite/probable FH is higher of very early myocardial infarction patients. Earlier lipid-lowering treatment can reduce coronary disease development, regardless of getting the optimal level.