老年冠心病患者下肢动脉硬化危险因素分析

Analysis of risk factors of senile coronary heart disease with arteriosclerosis obliterans

目的：探讨影响老年冠心病患者下肢动脉硬化闭塞症（LEASD）发生发展的相关危险因素。方法选择2014年1-3月哈尔滨医科大学附属第四医院冠心病患者114例为研究对象，采用彩色多普勒超声观察下肢血管狭窄程度，根据狭窄程度将其分为狭窄率≥70%组（n=21）和狭窄率〈70%组（n=53）。观察并分析两组患者年龄及伴发高血压、糖尿病、腔隙性脑梗死、高密度脂蛋白-胆固醇（HDL-C）降低、载脂蛋白A（apoA）降低、高同型半胱氨酸血症（HHCY）、超敏C反应蛋白（hs-CRP）增高等因素，并进行狭窄率≥70%者危险因素分析。结果①114例入选者检出下肢动脉硬化者74例，检出率为64.9%，平均年龄高于未检出下肢动脉硬化者，差异有统计学意义（P〈0.05），下肢动脉硬化患者均伴发腔隙性脑梗死。②狭窄率≥70%组≥90岁的患者所占比例明显高于狭窄率〈70%组，差异有高度统计学意义（P〈0.01）。③狭窄率≥70%组伴发高血压、糖尿病、HDL-C降低、HHCY、hs-CRP增高者多于狭窄率〈70%组，差异有统计学意义（P〈0.05）；而两组伴发apoA降低者比较，差异无统计学意义（P〉0.05）。④Logistic分析表明老年LEASD患者下肢血管狭窄率≥70%与高龄（〉90岁）、高血压、糖尿病、HDL-C降低、HHCY、hs-CRP增高密切相关（P=0.033、0.036、0.021、0.028、0.034、0.046）。结论①70岁以上老年冠心病患者下肢动脉硬化发生率高达64.9%；② LEASD血管狭窄程度与年龄具有一定的相关性；③高龄（〉90岁）、高血压、糖尿病、HDL-C降低、HHCY、hs-CRP增高是预测老年冠心病患者下肢动脉硬化狭窄率≥70%的独立危险因素。

Objective To investigate the risk factors affecting the occurrence of senile coronary heart disease （CHD） with lower extremity atherosclerosis disease （LEASD）. Methods 114 cases of patients with CHD from February to Jan-uary 2014 in the Fourth Affiliated Hospital of Harbin Medical University were selected as study objects, the stenosis degree of lower extremities vascular of all patients were observed by color doppler flow imaging, and they were divided into two groups according the degree of stenosis, stenosis rate〈70%group（n=53）and stenosis rate≥70%group（n=21）. The age and concomitant factors,such as hypertension, diabetes, lacunar cerebral infarction, low level of high-density lipoprotein cholesterol （HDL-C） and apolipoprotein A （apoA）, hyperhomocysteinemia （HHCY）, increased hypersensitive C-reactive protein （hs-CRP ） were observed and analyzed, and the risk factors of the patients with stenosis rate ≥70%were analyzed. Results ①74 cases of lower limb arteriosclerosis were occurred in 114 cases, accounts for 64.9%, the average age was higher than patients without lower limb arteriosclerosis, the difference was statistically significant （P〈0.05）, there was lacunar cerebral infarction in the patients with lower extremity atherosclerosis.②The proportion of pa-tients aged ≥90 years in the patients of stenosis rate≥70% group was higher than that of stenosi s rate 〈70% group, the difference was statistically significant （P〈 0.01）.③Patients with hypertension, diabetes, low level of HDL-C, HH-CY, high level of hs-CRP in stenosis rate≥70% group were more than those of the stenosis 〈 70% group, the differ-ences were statistically significant （P〈0.05）, while there was no difference in the two groups of patients with low level of apoA （P〉0.05）.④Logistic regression analysis showed that the elder （〉90 years）, hypertension, diabetes, low level of HDL-C, HHCY, high level of hs-CRP were closely related with older patients with LEASD whose stenosis≥70% （P= 0.033, 0.036, 0.021, 0.028, 0.034、0.046）. Conclusion①The incidence rate of lower limb arteriosclerosis is 64.9% in the patients of CHD over 70 years;②vascular stenosis of LEASD is related with age; ③hypertension, age〉90, diabetes, low level of HDL-C, HHCY, high level of hs-CRP are independent risk factors in prediction of elderly patients with CHD occurred lower limb atheroscle-rosis stenosis rate≥70%.