40岁以下青年冠心病患者冠状动脉造影的特点及其危险因素的Logistic回归分析

Coronary angiographic features in young patients with coronary heart disease under the age of 40 and Logistic regression analysis on its risk factors

目的 探讨40岁以下青年男性冠状动脉粥样硬化性心脏病（冠心病）患者冠状动脉造影的特点,并对其危险因素进行Logistic回归分析。方法 回顾性分析湘西自治州人民医院2012年1月至2015年1月行冠状动脉造影的85例青年（40岁以下）冠心病患者的资料,与同期62例青年对照组和151例老年冠心病患者的资料进行对比,分析其冠状动脉病变特点,并应用病例对照研究方法,对青年和老年冠心病的危险因素进行Logistic回归分析。结果 青年冠心病组以单支病变为主,占71.8%（61例）,其中前降支占77.0%（47例）,左主干病变仅占2.3%（2例）;老年冠心病组以三支病变为主,占36.4%（55例）,且左主干病变占8.6%（13例）。青年冠心病组危险因素的Logistic回归分析显示,冠心病家族史（OR=3.136,P=0.049,95%CI：1.00-9.80）、肥胖（OR=3.166,P=0.020,95%CI：1.20-8.34）、吸烟（OR=11.399,P=0.000,95%CI;3.95-32.87）、高胆固醇血症（OR=3.121,P=0.001,95%CI;1.60-6.07）是青年冠心病发病的独立危险因素。结论 青年冠心病患者冠状动脉造影特点以单支病变为主,常累及前降支。青年冠心病发病的重要因素是冠心病家族史、肥胖、吸烟、高胆固醇血症。青年冠心病的防治在于积极控制体质量、戒烟和改善饮食结构。

Objectives To investigate the coronary angiographic features in young patients with coronary heart disease （CHD） under the age of 40, and to analyze the risk factors by Logistic regression. Methods We analyzed the coronary angiographic features of 85 CHD cases （aged 25-40 years） and 151 CHD cases （aged 60-75 years） from January 2012 to January 2015 in The People＇s Hospital of Xiangxi Autonomous Prefeetur. At the same period, coronary angiographic features of 62 young controls in our hospital were analyzed. Logistic regression analysis was performed for the risk factors in the young and elderly patients with CHD by case-control study. Results The young CHD patients were mostly with single vessel disease （accounting for 71.8%, 61 cases）, most of which involved left anterior descending artery lesions （accounting for 77.0%, 47 cases）, and left main lesions accounted for 2.3% （2 cases）. The elderly CHD patients were mostly with triple-vessel disease （accounting for 36.4%, 55 cases）, and left main lesions accounted for 8.6% （13 cases）. Logistic regression analysis showed that family history of CHD （OR=3.136, P=0.049, 95%CI： 1.00-9.80）, obesity （0R=3.166, P=0.020, 95% CI： 1.20-8.34）, smoking （OR=11.399, P=0.000, 95% CI ： 3.95-32.87） and hypercholesterolemia （OR=3.121, P=0.001, 95% CI ： 1.60-6.07） were independent risk factors for young patients with CHD. Conclusions Coronary angiographic features of young patients with CHD are mostly single-vessel diseases, given priority to the anterior descending artery lesions. The major risk factors in young patients with CHD are family history of CHD, obesity, smoking and hypercholesterolemia. Prevention and treatment of CHD in young people is to control weight, quit smoking and improve diet structure.