性别对疑似冠心病患者的冠状动脉病变的影响

Prevalence, severity, characteristics and coronary calcified score of coronary artery plaques are different in women than men with suspected coronary artery disease

目的 分析冠状动脉病变的程度、性质及钙化积分在不同性别之间是否存在差异.方法 选取2011年9月至2013年12月在中国医科大学附属第一医院的3 752例疑似冠心病患者,所有患者都进行了256排冠脉CT检查并完成了冠脉钙化积分检测.研究评估了不同的性别与冠脉病变及钙化积分之间的联系.单因素及多因素的Logistic回归分析了不同性别与冠脉病变之间的关系.结果 3 752例患者中包括1 920例男性和1 832例女性,入选患者平均年龄（56±11）岁.研究人群中女性年龄更大,吸烟者更少.女性的冠脉病变、2支/3支病变、左主干病变、显著/严重病变的发生率显著低于男性（均P＜0.01）.女性的非钙化斑块的比率显著高于男性,而混合斑块的比率显著低于男性（均P＜0.01）.不同年龄层的女性病变中钙化积分＞0的比率都显著低于男性（均P＜0.01）.在调整了危险因素后发现女性是显著病变、严重病变、2支/3支病变、左主干病变、钙化斑块、混合斑块及钙化积分＞ 10的显著保护因素（均P＜0.01）.女性只在单因素分析中是非钙化斑块的保护因素（P＜0.01）.当女性年龄＞ 65岁后,女性对冠脉病变的保护因素全部转变成危险因素.结论 女性与男性相比冠脉病变的发生率低,病变程度轻,钙化积分低,非钙化斑块的比例也显著增高（即使年龄分层后）.随着年龄的增长,女性对冠脉病变的保护因素变成了危险因素.

Objective To validate the prevalence,severity,characteristics and coronary calcified score（CACS） of coronary artery plaques in women are different from men.Methods A total of 3 752 patients with suspected coronary artery disease in the First Affiliated Hospital of China Medical University were enrolled between September 2011 and December 2013.Patients with suspect CAD underwent 256-detecter coronary computed tomography （CCTA） and CACS measurement were enrolled.The differences of sex-associated coronary artery plaques were assessed.The univariable and multivariable Logistic regression were employ to assess the association female and male with coronary artery plaques.Results A total of 3 752 patients including 1 832 females and 1 920 males,the average age of the patients was （56 ± 11） years.Women were older and less smoker than men.The prevalences of any plaque,2-,3-/LM disease and significant/severe stenosis significantly decreased in female than male（all P 〈 0.01）.The proportion of noncalcified plaques significantly higher and mixed plaque significantly lower in female than male （all P 〈 0.01）.the proportion of women were significantly lower than men in CACS 〉 0 （all P 〈 0.01）.The similar tendency also happened in four age-matched female and male subgroups.After adjustment,female was the significant protective factor for significant and severe stenosis,2-and 3-/LM vessel disease,calcified and mixed plaques,and CACS 〉 100（all P 〈0.01）;female was the significant protective factor for non-calcified plaques in the univariate analysis（P 〈 0.01）.When the age ≥ 65,female became the significant risk factor for coronary artery plaques （all P 〈 0.01）.Conclusions Women have less prevalence and extensive coronary artery plaques and lower CACS,the plaque characteristics in women is more frequently composed by non-calcified plaques than men,even after matched by age.With age,female change from a protective factor to a risk factor for coronary artery plaques.