正常LDL-C浓度老年冠心病患者心血管危险因素及冠状动脉病变严重程度分析

Cardiovascular risk factor and artery disease severity in elderly coronary heart disease inpatients cohort with normal low-density lipoprotein cholesterol concentrations

目的分析正常低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)浓度老年住院冠状动脉粥样硬化性心脏病(冠心病)患者的心血管危险因素及冠状动脉病变严重程度。方法选择年龄≥60岁,2013年3月至2013年12月在中山大学孙逸仙纪念医院心内科住院,经冠状动脉血管造影诊断为冠心病的患者共279例,其中LDL-C<3.10 mmol/L为正常浓度LDL-C组,共89例;LDL-C≥3.10 mmol/L为高浓度LDL-C组,共190例。收集患者临床资料、血脂生化及冠状动脉病变支数,应用SPSS18.0软件统计分析。结果 (1)正常浓度LDL-C组高脂血症病史显著低于高浓度LDL-C组,而收缩压显著高于高浓度LDL-C组,差异均有统计学意义(P=0.01和P=0.022)。(2)正常浓度LDL-C组血清总胆固醇、LDL-C浓度显著低于高浓度LDL-C组,差异有统计学意义(P均<0.01);而血清三酰甘油、高密度脂蛋白胆固醇浓度显著高于高浓度LDL-C组,差异有统计学意义(P均<0.01)。(3)正常浓度LDL-C组中,三支血管病变9例(10.11%)显著低于高浓度LDL-C组51例(26.84%),而两支血管病变47例(52.81%)显著高于高浓度LDL-C组73例(38.42%),差异亦有统计学意义(P=0.002和P=0.028)。结论正常LDL-C浓度的老年住院冠心病患者中收缩压控制欠佳及高三酰甘油血症可能是其主要心血管危险因素,其三支血管病变严重程度低于高浓度LDL-C患者。

Objectives To investigate the cardiovascular risk factor and the artery disease severity in elderly coronary heart disease inpatients cohort with normal low-density lipoprotein cholesterol（LDL-C） concentrations. Methods We selected 279 inpatients above 60 years old with coronary artery disease confirmed by coronary angiography in Sun Yatsen Memorial Hospital of Sun Yat-sen University from March 2013 to December 2013, including 89 cases with serum concentrations of LDL-C below 3.10 mmol / L（normal LDL-C group） and 190 patients with serum concentrations of LDL-C no less than 3.10 mmol / L（high LDL-C group）. General information and blood biochemical data were collected and analyzed by SPSS 18.0. Results（1） Hyperlipidemia history was significantly lower（P =0.01） and systolic blood pressure was significantly higher（P=0.022） in normal LDL-C group when compared with those in high LDL-C group.（2） Serum concentrations of total cholesterol（TC） and LDL-C were significantly lower in normal LDL-C group, while serum concentrations of triacylglycerol（TG） and high-density lipoprotein cholesterol（HDL-C） were significantly higher when compared with those in high LDL-C group（P〈0.01）.（3） Percentage of triple-vessel heart disease patients in each group exhibited statistical significance（P = 0.002）, with 10.11%（9 / 89） in normal LDL-C group and 26.84%（51 /190） in high LDL-C group respectively. Percentage of double-vessel heart disease patients also demonstrated strong statistical significance（P = 0.028） between the two groups, with 52.81%（47 / 89） in normal LDL-C group and38.42%（73 / 190） in high LDL-C group. Conclusions In elderly coronary heart disease patients with normal serum concentrations of LDL-C, the inability of controling systolic blood pressure and hypertriglyceridemia may be the main risk factors of cardiovascular disease. Severity of triple-vessel heart disease is lower in normal LDL-C group compared with that in high LDL-C group.