围绝经期女性冠状动脉粥样硬化性心脏病患者相关危险因素及心脏功能研究

Related risk factors and cardiac function in peri-menopausal patients with coronary heart disease

目的探讨围绝经期女性冠状动脉粥样硬化性心脏病（冠心病）患者相关危险因素及心脏功能。方法选择2013年12月至2014年12月于首都医科大学附属北京安贞医院就诊的围绝经期女性冠心病患者220例作为观察组，另选同一时期男性冠心病患者220例作为对照组，比较2组患者冠状动脉病变特点、各项生化指标、超声心动图指标的差异。结果观察组冠状动脉单支病变比例明显高于对照组[32．7％（72／220）比16．8％（37／220）]，三支病变和左主干＋三支病变比例明显低于对照组[27．7％（61／220）比36．8％（81／220），4．5％（10／220）比12．3％（27／220）]，差异均有统计学意义（均P〈0．05）。2组双支病变比例差异无统计学意义（P〉0．05）。观察组总胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、C反应蛋白、血尿酸水平明显低于对照组[（4．1±0．9）mmol／L比（4．5±1．2）mmol／L，（2．4±0．8）mmol／L比（2．8±1．0）mmol／L，10．2（7．4，13．6）μmol／L比15．3（12．8，20．8）μmol／L，1．11（0．41，2．68）mg／L比2．17（0．69，7．65）mg／L，（319±91）μmol／L比（374±103）μmol／L]，高密度脂蛋白胆固醇明显高于对照组[（0．97±0．23）mmol／L比（0．90±0．19）mmol／L]，差异有统计学意义（P〈0．05）；2组其余指标比较，差异无统计学意义（P〉0．05）。观察组左心房内径、左心室舒张末期内径、室间隔厚度、左心室后壁厚度明显小于对照组[（37±7）mm比（42±10）mm，（48±5）mm比（50±6）mm，（9．8±3．8）mm比（10．3±1．2）mm，（8．9±1．3）mm比（9．8±1．5）mm]，左心室射血分数明显高于对照组[（63±10）％比（61±10）％]，差异均有统计学意义（P〈0．05）。结论围绝经期女性冠心病患者与男性患者相比血脂水平和动脉粥样硬化风险较低，心脏功能、结构较好。

Objective To explore the related risk factors and cardiac function in peri-menopausal patients with coronary heart disease. Methods Totally 220 peri-menopausal female patients with coronary atherosclerotic heart disease from December 2013 to December 2014 were selected as observation group; another 220 male patients with coronary heart disease were matched and selected as control group. The characteristics of coronary artery lesion, biochemical and echocardiographic indicators were compared between the two groups. Results The proportion of single vessel diseases in observation group was significantly higher than that in control group [ 32.7% （72/220） vs 16. 8% （37/220） ], the proportion of three-vessel disease and proportion of left main coronary artery ＋ three-vessel diseases in observation group were significantly lower than those in control group [ 27.7% （61/220） vs 36.8% （81/220） ,4.5% （10/220） vs 12.3% （27/220） ] （ both P 〈 0. 05 ） ; the proportion of double vessel disease had no significant difference between groups （ P 〉 0. 05 ）. The levels of total cholesterol, low density lipoprotein cholesterol, homocysteine, C reactive protein and blood uric acid in observation group were significantly lower than those in control group [（4.1 ± 0.9） mmol/L vs （4.5 ±1.2） mmol/L, （2.4± 0.8） mmol/Lvs （2.8±1.0） mmol/L, 10.2 （7.4, 13.6） μmol/L vs 15.3 （12.8, 20.8） μmol/L, 1.11 （0. 41, 2. 68） mg/L vs 2. 17 （0. 69, 7.65） mg/L, （319 ±91 ） μmol/L vs （374 ± 103）μmol/L] ,the level of high density lipoprotein cholesterol was significantly higher than that in control group [ （ 0. 97 ±0. 23 ） mmol/L vs （0. 90 ± 0. 19 ） mmol/L ] （ P 〈 0. 05 ）. Other biochemical indicators had no significant differences between groups （P 〉 0. 05）. The left atrium diameter, left ventricular end-diastolic diameter, interventricular septum thickness, left ventricular posterior wall thickness in observation group were significantly smaller than those in control group [（37±7） mmvs （42±10） mm, （48±5） mm vs （50±6） mm, （9.8±3.8） mm vs （10.3±1.2） ram, （8.9 ± 1.3） mm vs （9.8 ±1.5） mml , the left ventricular ejection fraction was significantly higher than that in control group [（63 ±10）% vs （61 ±10）% ] （P 〈0.05）. Conclusion The peri-menopausal women with coronary heart disease have lower blood lipid level and atherosclerosis risk, better heart function and structure compared with female patients.