女性绝经前后冠状动脉粥样硬化性心脏病危险因素的对比研究

Comparison study of risk factors between premenopausal and postmenopausal female patients with coronary heart disease

目的探讨女性绝经前后冠状动脉粥样硬化性心脏病(CHD)危险因素的变化。方法将283例女性按是否患CHD分CHD组154例,对照组129例;按绝经与否分绝经前组78例(绝经前CHD组34例,绝经前对照组44例),绝经后组205例(绝经后CHD组120例,绝经后对照组85例)。记录患者年龄、体质指数(BMI)、基础病史和月经情况。检测总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(v LDL-C)、载脂蛋白(Apo)AI、Apo B、脂蛋白a(Lpa)、同型半胱氨酸(HCY)、高敏C反应蛋白(hs CRP)。结果 CHD组的年龄、CHO、TG、LDL-C、v LDL-C、Lpa、Apo B、hs CRP水平,高血压史、糖尿病史、冠心病家族史比例均高于对照组,HDL-C低于对照组;绝经前、后CHD组高血压史、糖尿病史比例,CHO、TG、LDL-C、v LDL-C、Lpa、Apo B、hs CRP水平均分别高于其对照组;绝经后CHD组HDL-C低于绝经后对照组。高血压、糖尿病、LDL-C是绝经前CHD的独立危险因素;高血压、糖尿病、CHO是绝经后CHD的独立危险因素,HDL-C是保护因素。绝经后CHD组高血压比例、CHO、LDL-C高于绝经前CHD组。结论绝经后女性CHD患者血压异常和血脂紊乱较绝经前更为普遍,应积极控制上述因素以改善其预后。

Objective To explore changes of risk factors between premenopausal and postmenopausal female patients with coronary heart disease （CHD）. Methods A total of 283 female patients were divided into CHD group （n=154） and con-trol group （n=129） according to whether they suffered from CHD or not. Patients were further stratified into two groups accord-ing to menopausal situation：premenopausal group （n=78, including premenopausal CHD group of 34 cases and premenopaus-al control group of 44 cases） and postmenopausal group （n=205, including postmenopausal CHD group of 120 cases and post-menopausal control group of 85 cases）. Clinical data of age, body mass index （BMI）, medical history and menses situation were recorded. The levels of cholesterol （CHO）, triglycerides （TG）, high density lipoprotein cholesterol （HDL-C）, low density lipo-protein cholesterol （LDL-C）, very low density lipoprotein cholesterol （vLDL-C）, apolipoprotein AI （ApoAI）, apolipoprotein B （apoB）, lipoprotein a （Lpa）, homocysteine （HCY） and high-sensitive C-reactive protein （hsCRP） were also detected. Results There were significantly higher levels of age, CHO, TG, LDL-C, vLDL-C, Lpa, ApoB, hsCRP, and the ratio of hypertension history, diabetic history, coronary heart disease family history in CHD group than those of control group. The level of HDLc was significantly lower in CHD group than that of control group. The ratio of hypertension history, diabetic history and levels of CHO, TG, LDL-C, vLDL-C, Lpa, ApoB, hsCRP were significantly higher in both premenopausal and postmenopausal CHD groups than those of their control groups. The level of HDL-C was significantly lower in postmenopausal CHD group than that of postmenopausal control group （P〈0.05）. Hypertension history, diabetic history and LDL-C were the independent risk fac-tors of premenopausal CHD. Hypertension history, diabetic history and CHO were the independent risk factors of postmeno-pausal CHD, and HDL-C was the protecting factor of CHD. The ratio of hypertension history, the level of CHO and LDL-C were significantly higher in postmenopausal CHD group than those of premonopausal CHD group. Conclusion The abnor-mal blood pressure level and dyslipidemia are more prevalent in postmenopausal female patients with CHD than premeno-pausal female patients. We should control these risk factors to improve the prognosis.