女性早发冠心病相关危险因素分析

Premature coronary heart disease in women related risk factor analysis

目的：分析女性早发冠心病相关危险因素,以给予早期干预及治疗。方法：回顾性分析2013年1月至2015年1月,我院经冠状动脉造影明确的女性早发冠心病（〈65岁）患者144例,与同期冠状动脉造影除外的冠心病的女性患者94例,对两组患者的危险因素进行统计学分析,并行多因素分析筛选女性早发冠心病的危险因素。结果：单因素分析提示,早发冠心病组与对照组比,两组间绝经年龄构成差异有统计学差异（P〈0.05）,早发冠心病组糖尿病患病率37.5%,高于对照组（P〈0.05）,同时糖化血红蛋白值亦高于对照组（P〈0.05）。两组间血液学指标进行比较分析,早发冠心病组HDL-C水平和载脂蛋白A-1较对照组低,载脂蛋白B水平更高,同型半胱氨酸水平高于对照组,肾小球滤过率水平早发冠心病组低于对照组（P〈0.05）。多因素Logistic回归分析提示：〈45岁绝经（OR=6.103,95%CI：1.502~24.789,P=0.011）、合并糖尿病（OR=3.677,95%CI：1.271~10.635,P=0.016）、高糖化血红蛋白水平（OR=4.341,95%CI：1.341~87.279,P=0.031）、载脂蛋白B（OR=2.803,95%CI：1.114~7.055,P=0.029）、肾小球滤过率下降（OR=1.011,95%CI：1.02~6.69,P=0.031）、高同型半胱氨酸血症（OR=1.980,95%CI：1.02~6.69,P=0.032）是早发冠心病的危险因素。载脂蛋白A-1（OR=0.271,95%CI：0.109~0.674,P=0.005）为保护性因素。结论：女性早发冠心病患者绝经年龄更早,合并糖尿病患者多,且糖化血红蛋白水平更高,为早发冠心病的危险因素。载脂蛋白B、肾小球滤过率下降、高同型半胱氨酸血症为女性早发冠心病的危险因素,载脂蛋白A是女性早发冠心病的保护性因素。

Objective： Analysis of premature coronary heart disease in women of associated risk factors, in order to give early intervention and treatment. Methods： A retrospective analysis in January 2013 to January 2015, 144 patients of premature coronary heart disease in women （ 〈 65 years old） by coronary angiography, compared with coronary angiography except for women with coronary heart disease, 94 people, for the statistical analysis of risk factors for the 2 groups of patients, parallel multiple factors analysis to screen a risk factor for premature coronary heart disease in women. Results： Premature coronary heart disease in the single factor anal- ysis of group and the control group, menopausal age composition difference, it was statistically difference between the two groups （P = 0. 029）, the premature coronary heart disease group 37. 5% higher than that of control group （ P = 0. 003 ）, and glycated hemoglobin values are higher than the control group （ P = 0. 006 ）. Compares and analyses the hematology indexes between the two groups of premature coronary heart disease group of high- density lipoprotein levels and apolipoprotein A-1 was lower than those of control group, the higher levels of apo- lipoprotein B, homocysteine levels higher than the control group, Premature coronary heart disease in glomeru- lar filtration rate is lower than the control group（ P 〈 0.05 ）. Multiariable logistic regression analysis： less than 45 years old menopause （OR =6. 103,95% CI：I. 502-24. 789, P =0. 011 ）, diabetes mellitus （ OR = 3.677, 95% CI：I. 271 - 10. 635, P = 0. 016）, the high hemoglobin A lc levels （OR = 4. 341,95% CI： 1. 341-87. 279,P = 0.031 ）, apolipoprotein B （ OR = 2. 803,95% CI： 1. 1 14-7. 055, P = 0. 029 ）, glomerular filtration rate de- creased （ OR = 1.011,95% CI： 1.02-6. 69, P = 0. 031 ）, high homocy＇steine levels （ OR = 1. 980,95% CI： 1.02- 6. 69, P =0. 032） is a risk factor for early onset coronary artery disease. Apolipoprotein A （ OR =0. 271, 95% CI：O. 109-0. 674, P = 0. 005 ） as the proteetive factors. Conclusion： Diabetes mellitus, and glycosylated hemo- globin levels higher, as a risk factor for premature coronary heart disease. Apolipoprotein B, glomerular filtration rate decreased, homocysteine blood fats as a risk factor for premature coronary heart disease in women, apoli- poprotein A is protective factors of premature coronary heart disease in women.