不同性别冠状动脉粥样硬化性心脏病患者危险因素分析

Multiple risk factors models of patients with coronary heart disease of different genders

目的通过建立不同性别患者冠状动脉粥样硬化性心脏病（CHD）的多重危险因素回归模型,分析各危险因素对CHD的致病风险。方法连续入选2009年1月至2018年1月,于承德医学院附属医院心脏内科住院,并符合纳入标准的对象8028例,女性2894例,男性5134例;同时连续入选同期住院经冠状动脉造影排除CHD的患者作为对照组（336例）,女性129例,男性207例。收集患者的人口学特征及临床资料,分别建立不同性别CHD患者的多因素Logistic回归模型。结果年龄〉55岁、血脂异常、2型糖尿病、高血压病等均为CHD患病的独立危险因素（均P〈0.05）,但各因素对女性与男性CHD的致病风险不同。女性55岁以后,年龄每增加10岁,CHD患病风险增加2.597倍,而男性则增加1.424倍（P〈0.05）;血脂异常、高血压病、2型糖尿病、冠心病家族史,导致女性患CHD的风险（OR）分别为3.297、1.484、3.187、3.714倍（均P〈0.05）,血脂异常、高血压病、2型糖尿病、现症吸烟,导致男性患CHD的风险（OR）分别为1.398、1.800、2.303、5.642倍（均P〈0.05）。女性患者以冠心病家族史、2型糖尿病、血脂异常致病危险最高,尤其冠心病家族史最显著;而男性以现症吸烟、高血压病导致男性CHD的发病风险最高,现症吸烟尤为显著。结论血脂异常、高血压病、2型糖尿病、吸烟等危险因素,对不同性别患者导致CHD的危险不同,在CHD的一级与二级预防中应予积极防治。

Aim To establish the multiple risk factors models for patients with coronary heart disease（CHD） of different genders and then quantitatively analyze the risk of all factors. Methods A total of 8028 CHD inpatients and a control group of 336 cases without significant coronary artery stenosis were enrolled consecutively from January 2009 to January 2018. And they were divided into 4 groups of female CHD（n = 2894）,male CHD（n = 5134）,female control（n =129） and male control（n = 207）. All demographic and clinical data were collected by the physicians and master degree candidates in the division of cardiology. Results The Logistic regression models of multiple risk factors were established for CHD by different genders. More than 55 years of age,dyslipidemia,type 2 diabetes mellitus and hypertension were all independent risk factors of CHD for different genders（P〈0.05）. However,the same risk factor had dramatically different pathogenic effects on CHD in male and female. The odds ratio（OR） was markedly different for females and males patients,per 10-year increased over 55 years old（2.597 vs 1.424）,dyslipidemia（3.297 vs 1.398）,hypertension（1.484 vs. 1.800）,type 2 diabetes mellitus（3.187 vs 2.303）,respectively（all P〈0.05）. In addition,the family history of CHD increased the risk of CHD attack in females by 3.714 times（P〈0.05）. Comparatively speaking,the history of smoking increased the risk of CHD attack in males by 5.642 times（P〈0.05）. Conclusions Dyslipidemia and type 2 diabetes mellitus may present higher risk of CHD attack in females than males. However,history of smoking and hypertension are much more dangerous for males with CHD.