三种临床类型冠状动脉粥样硬化性心脏病与吸烟的关系及其独立危险因素分析

Relation between different types of coronary artery diseases and cigarette smoking

目的 分析3种不同临床类型冠状动脉粥样硬化性心脏病（冠心病）的独立危险因素及其与吸烟的关系。方法 选取经冠状动脉造影的患者1 249例，根据病情分为4组：非冠心病组（335例）、稳定型心绞痛（AP）组（121例）、不稳定型心绞痛（UAP）组（461例）和急性心肌梗死（AMI）组（332例）。采集各组患者性别、年龄、体重指数、高血压、糖尿病、脑血管疾病、慢性肾脏病、外周血管病、家族史、饮酒史、吸烟年限、每日吸烟量、吸烟指数、戒烟年限、总胆固醇、三酰甘油、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖、高敏C反应蛋白（hsCRP）等资料，以单因素分析筛选3种不同临床类型冠心病的危险因素，并进一步行多因素Logistic回归分析吸烟与3种类型冠心病发病的关系。结果①经单因素分析，男性比例、糖尿病、脑血管疾病、平均年龄、吸烟年限、每日吸烟量、吸烟指数与3种类型冠心病的发病均呈不同程度正相关（P〈0.05或P〈0.01）。其中，吸烟年限、每日吸烟量及吸烟指数均与3种类型冠心病发病呈明显正相关（均P〈0.01）。除上述危险因素外，AP还与高血压、慢性肾脏病相关（P〈0.05），UAP与高血压、空腹血糖、hsCRP、HDLC相关（P〈0.05），AMI则还与慢性肾脏病、空腹血糖、hsCRP、HDLC相关（P〈0.05）。②Logistic回归分析显示：吸烟指数为AP、UAP、AMI 3组冠心病发病的独立危险因素[比值比（OR）均为1.001；95%置信区间（CI）分别为1.000-1.002、1.000-1.001、1.000-1.002；P=0.008、0.001、0.009］。除吸烟指数外，性别、年龄、高血压为AP发病独立危险因素（OR=2.617、1.050、4.826；95%CI分别为1.438-4.762、1.025-1.076、2.485-9.373；均P〈0.01）；性别、年龄、糖尿病、hsCRP为UAP发病独立危险因素（OR=1.464、1.043、1.643、1.078；95%CI分别为1.005-2.133、1.027-1.059、1.068-2.526、1.034-1.124；均P〈0.05）；性别、年龄、糖尿病、HDLC、空腹血糖、hsCRP为AMI发病独立危险因素（OR=2.832、1.053、0.459、0.304、1.423、1.156；95%CI分别为1.609-4.984、1.032-1.075、0.236-0.891、0.136-0.682、1.250-1.619、1.156-1.240；均P〈0.05）。结论吸烟为3种不同临床类型冠心病发病的共同独立危险因素，3种类型冠心病的独立危险因素不完全相同。

Objective To investigate the relation between different types of coronary heart disease （CHD） and cigarette smoking. Methods A total of 1249 patients undergoing coronary angiography were studied retrospectively. Patients were divided into four groups （A group： 335 patients without CHD, B group： 121 patients with stable angina pectoris, C group： 461 patients with unstable angina pectoris： D group： 332 patients with acute myocardial infarction）. Gender, age, body mass index, hypertension, diabetes mellitus, cerebrovascular disease, chronic kidney disease, peripheral vascular disease, CHD family history, alcohol consumption history, cigarette smoking history, total cholesterol, triglyceride, highdensity lipoprotein cholesterol （HDL-C）, lowdensity lipoprotein cholesterol （LDL-C）, plasma glucose under fasting （GLU） and highsensitivity C protein （hsCRP） were analyzed by univariate analysis and multiple logistic regression. Results①Through univariate analysis male diabetes mellitus, cerebrovascular disease, advanced age and smoking showed different degrees of positive correlation with different types of CHD （P〈0.05 or P〈0.01）. Smoking showed significant correlation with all types of CHD（all P〈0.01）. In addition, hypertension, chronic kidney disease showed correlation with B group. Hypertension, GLU, hsCRP and HDLC showed correlation with C group. Chronic kidney disease, GLU, hsCRP and HDLC showed correlation with D group. ②In multiple logistic regression, smoking showed significant independent association with B, C and D group; the odds ratio （OR） of the three groups was 1.001; P values were 0.008, 0.001, 0.009 respectively. In addition to smoking, male, advanced age and hypertension were independent risk factors for B group（OR=2.617, 1.050,4.826;95% CI：1.438-4.762,1.025-1.076,2.485-9.373;P〈0.01）. Male, advanced age, diabetes mellitus and hsCRF were the independent risk factors of C group（OR=1.464,1.043,1.643,1.078;95% CI：1.005-2.133,1.027-1.059,1.068-2.526,1.034-1.124;P〈0.05）. Male, advanced age, diabetes mellitus, HDLC, GLU and hsCRF were independent risk factors for D group （OR=2.832,1.053,0.459,0.304, 1.423,1.156;95% CI：1.609-4.984,1.032-1.075,0.236-0.891,0.136-0.682,1.250-1.619,1.156-1.240;P〈0.05）. Conclusion Cigarette smoking is a significant independent risk factor for all types of CHD. The independent risk factors of different types of CHD are partially conformed.