农村和城镇冠心病患者冠状动脉病变严重程度差异比较及其影响因素

Comparison of severity of coronary artery disease between urban and rural patients

目的观察和分析西北地区农村与城市冠心病患者冠状动脉病变(CAD)严重程度的差异及其影响因素。方法纳入接受冠状动脉造影的患者共3 121例,按参加医保的方式不同分为城镇患者和农村患者两组。比较两组基线资料和临床生化指标的差异;以Gensini评分为指标,比较两组患者CAD严重程度的差别并分析其可能的影响因素。结果农村患者的CAD严重程度较城镇患者更重(Gensini评分,P <0. 001),急性心肌梗死比例和血hs-CRP水平显著高于城镇患者(P <0. 001);而城镇患者中糖尿病和高血压的发病率更高,非冠心病和心绞痛患者的比例以及血肌酐和尿酸水平均高于农村患者;亚组分析结果显示农村与城镇患者CAD严重性的差异主要与冠心病亚型分布比例不同有关(P <0. 05)。结论农村患者的CAD严重程度比城镇患者更重,这种差异主要与两组患者中冠心病亚型分布比例不同有关。

Objective To investigate the difference of severity of coronary artery disease( CAD) and its influencing factors in rural and urban coronary heart disease patients in Northwest China. Methods A total of 3 121 patients who underwent coronary angiography were recruited and divided into two groups: urban group and rural group according to the way they participated in medical insurance.Baseline characteristics and clinical biochemical indicators between the two groups were compared. The Gensini score was used as an indicator to compare the difference of CAD severity between the two groups. Results The severity of CAD in rural patients was more serious than that in urban patients( Gensini score,P < 0. 001),and the proportion of acute myocardial infarction and blood hs-CRP levels were significantly higher( P < 0. 001). The incidence of diabetes and hypertension was higher in urban patients than in rural patients. The proportions of patients with non-coronary heart disease and angina pectoris were higher in urban patients than in rural patients. Serum creatinine and uric acid levels were also higher in urban patients than in rural patients. Subgroup analysis showed that the difference of CAD severity between rural and urban patients was mainly related to the difference of the distribution of coronary heart disease subtypes( P < 0. 05). Conclusion The severity of CAD in rural patients is more serious than that in urban patients,which is mainly associated with the different distribution proportion of CAD subtypes.