青年女性冠状动脉粥样硬化性心脏病患者的临床特点及发病相关危险因素分析

Clinical features and risk factors of coronary atherosclerotic heart disease in young women

目的探讨青年女性冠状动脉粥样硬化性心脏病（冠心病）患者的临床特点及发病相关危险因素。方法回顾性分析首都医科大学附属北京安贞医院心内科2015年1月至2016年12月以冠心病为出院诊断的1 315例青年患者的临床资料，其中男1 233例、女82例，收集2组患者的一般资料、既往病史、血生化指标以及临床病变特点，并选取同期进行冠状动脉造影结果未见异常的女性患者72例作为对照组，采用多因素Logistic回归法分析青年女性冠心病患者发病相关危险因素。结果女性患者吸烟、饮酒比例低于男性患者，甲状腺功能减退的患病率高于男性患者，差异有统计学意义［15.9%（13/82）比69.9%（862/1 233）、3.7%（3/82）比24.0%（296/1 233）、11.0%（9/82）比3.5%（43/1 233）］（P〈0.05），不同性别患者在年龄、体重指数、高血压、高胆固醇血症、糖尿病患病率、早发心血管疾病家族史方面差异无统计学意义（P〉0.05）。女性冠状动脉单支病变患者所占比例高于男性患者［45.1%（37/82）比40.1%（495/1 233）］，3支病变患者所占比例几乎与男性患者持平，总体比例差异无统计学意义（P〉0.05）。青年女性冠心病患者超重、吸烟、高血压、高胆固醇血症、糖尿病、甲状腺功能减退、早发心血管疾病家族史比例，总胆固醇、低密度脂蛋白胆固醇、空腹血糖水平均明显高于对照组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示与青年女性冠心病相关的危险因素为超重、吸烟、早发心血管疾病家族史、高血压、糖尿病、高低密度脂蛋白胆固醇血症（回归系数=1.46、2.52、2.11、1.80、1.93、1.39，均P〈0.05）。结论青年女性冠心病患者以冠状动脉单支病变及前降支病变多见，Gensini评分在数值上低于男性患者。超重、吸烟、早发心血管疾病家族史、高血压、糖尿病、高低密度脂蛋白胆固醇血症是其发病的独立危险因素，此外，甲状腺功能减退也可能与青年女性冠心病的发病相关。

ObjectiveTo investigate clinical features and risk factors of coronary atherosclerotic heart disease（CHD） in young women. MethodsFrom January 2015 to December 2016, 1 315 young patients（1 233 males and 82 females） of CHD in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; 72 women with normal coronary angiography results were collected as control group. General clinical data, medical histories, blood biochemical indexes and features of CHD were analyzed. Risk factors of CHD in young women were analyzed by multivariate logistic regression. ResultsSmoking and alcohol drinking rates in female patients were significantly lower and hypothyroidism rate was significantly higher than those in male patients[15.9%（13/82） vs 69.9%（862/1 233）, 3.7%（3/82） vs 24.0%（296/1 233）, 11.0%（9/82） vs 3.5%（43/1 233）]（P〈0.05）. There were no significant differences of age, body mass index, hypertension rate, hypercholesterolemia rate, diabetes rate and family history of premature cardiovascular disease rate between female and male patients（P〉0.05）. The proportion of single vessel lesion in female patients was higher than that in male patients[45.1%（37/82） vs 40.1%（495/1 233）]; the proportion of triple vessel lesions had no significant difference between female and male patients（P〉0.05）. Rates of overweight, smoking, hypertension, hypercholesterolemia, diabetes, hypothyroidism and family history of premature cardiovascular disease, levels of total cholesterol, low-density lipoprotein cholesterol and fasting blood glucose in female patients with CHD were significantly higher than those in control group（P〈0.05）. Multivariate logistic regression analysis showed that overweight, smoking, family history of premature cardiovascular disease, hypertension, diabetes and hypercholesterolemia were CHD-related risk factors（r=1.46, 2.52, 2.11, 1.80, 1.93, 1.39; P〈0.05）. ConclusionsSingle coronary lesion and anterior descending lesion are more common in young female patients with CHD; the Gensini score in female CHD ia lower than that in male CHD. Overweight, smoking, family history of premature cardiovascular disease, hypertension, diabetes and hypercholesterolemia are independent risk factors of CHD in young women; hypothyroidism may also be associated with female CHD.