冠心病患者冠状动脉病变进展的相关危险因素的研究

Risk factors related to coronary lesion progress in patients with coronary heart disease

目的探讨影响初发冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉病变进展的相关危险因素。方法纳入2008年1月至2012年12月在北京电力医院心内科行冠脉造影检查(CAG)的患者122例,所有患者初次行CAG检查时被确诊为冠心病,在此期间完成第2次CAG检查。根据两次CAG检查结果将患者分为冠脉病变进展组和无进展组。比较两组患者基线时的冠心病相关危险因素包括性别、年龄、吸烟史、高血压病史、糖尿病病史、血脂水平和冠脉病变的特点,采用二分类logistic回归分析研究冠脉病变进展的独立预测因素。结果两次冠脉造影检查平均间隔时间为(33.4±19.5)个月。第2次冠脉造影检查时71例(58.2%)患者有冠脉病变进展,51例(41.8%)患者无冠脉病变进展。与无进展组患者相比,进展组患者基线吸烟者比例更高(59.2%vs.39.2%,P=0.03),基线高密度脂蛋白胆固醇(HDL-C)水平较低(0.97±0.25 mmoL/L vs.1.18±0.25 mmoL/L,P=0.029),基线冠脉造影三支病变者更多(38.0%vs.15.7%,P=0.007),更多患者基线冠脉造影检查时行经皮冠状动脉介入(PCI)治疗(88.7%vs.70.6%,P=0.011)。二分类logistic回归分析显示,基线HDL-C水平(OR=0.167,95%CI:0.033～0.854,P=0.032),基线冠脉造影检查时接受PCI治疗(OR=3.281,95%CI:1.268～8.491,P=0.014),基线时冠脉三支病变(OR=4.289,95%CI:1.447～12.712,P=0.009)和两次冠脉造影检查间隔时间(OR=1.029,95%CI:1.007～1.052,P=0.01)是冠脉病变进展的独立预测因素。结论基线HDL-C水平、基线冠脉造影时接受PCI治疗、三支病变和两次冠脉造影检查间隔时间是冠心病进展的独立预测因素。

Objective To discuss the risk factors related to coronary lesion progress in the patients with coronary heart disease （CHD）. Methods The patients （n=122） with coronary angiography （CAG） examinations were chosen from Jan. 2008 to Dec. 2012, and all patients were diagnosed with CHD in the first CAG and they were given the second CAG. All patients were divided into progress group and non-progress group according to the outcomes of 2 times of CAG. The baseline risk factors related to CHD were compared between 2 groups including sex, age, smoking history, hypertension history, diabetes history, level of blood fat and features of coronary lesion. The independent predictors of coronary lesion progress were studied by using binary logistic regression analysis. Results The mean interval was （33.4±19.5） between 2 times of CAG. In the second CAG there were 71 patients （58.2%） with coronary lesion progress and 51 （41.8%） without coronary lesion progress. Compared with non-progress group, the percentage of baseline smoking patients was higher （59.2%vs. 39.2%, P=0.03）, baseline level of high-density lipoprotein-cholesterol （HDL-C） was lower （0.97±0.25 mmoL/L vs. 1.18±0.25 mmoL/L, P=0.029）, more patients had 3-vessel lesion during baseline CAG （38.0%vs. 15.7%, P=0.007）, and more patients had percutaneous coronary intervention （PCI） during baseline CAG （88.7%vs. 70.6%, P=0.011） in progress group. The binary logistic regression analysis showed that baseline HDL-C level （OR=0.167, 95%CI： 0.033-0.854, P=0.032）, PCI during baseline CAG （OR=3.281, 95%CI：1.268-8.491, P=0.014）, 3-vessel lesion during baseline CAG （OR=4.289, 95%CI：1.447-12.712, P=0.009） and mean interval between 2 times of CAG （OR=1.029, 95%CI：1.007-1.052, P=0.01） were the independent predictors of coronary lesion progress. Conclusion The baseline HDL-C level, PCI during baseline CAG, 3-vessel lesion during baseline CAG and mean interval between 2 times of CAG are the independent predictors of coronary lesion progress.