家族性高胆固醇血症的临床特点及其与早发心肌梗死的关系

Clinical characteristics of familial hypercholesterolemia and its correlation with early myocardial infarction

目的观察家族性高胆固醇血症(familial hypercholesterolemia,FH)的临床特点,并探讨其与早发心肌梗死(myocardial infarction,MI)的相关性。方法将潍坊阳光融合医院2000年1月至2018年12月收治的5 584例MI患者资料纳入此次回顾性分析,以男性<55岁、女性<60岁为早发标准,将患者分别纳入早发MI组、非早发MI组,参照荷兰临床脂质网络(Dutch lipid clinic network,DLCN)标准,计算两组患者FH患病率并比较FH患者、非FH患者的临床特点,运用Logistic多因素回归分析,总结FH对早发MI的影响。结果 5 584例患者中,2532例为早发MI,其余3 052例为非早发MI;共有252例患者确诊FH,其中早发MI组220例,非早发MI组32例,早发MI组FH患病率为8.67%,高于非早发MI组的1.05%,差异有统计学意义(P<0.05)。FH组年龄、体质量指数(body mass index,BMI)低于非FH组,其总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(lowdensity lipoprotein cholesterol,LDL-C)、三酰甘油(triglyceride,TG)浓度高于非FH组;FH组男性比例、原发性高血压(高血压)患病率、糖尿病患病率低于非FH组,其冠状动脉粥样硬化性心脏病(冠心病)家族史比例高于非FH组,差异有统计学意义(P<0.05)。Logistic多因素回归分析示,校正体质量指数、TC、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)等传统危险因素后,FH是导致早发MI的独立危险因素,较非FH患者而言,FH患者早发MI风险上升20.122倍(P<0.05)。结论 FH是导致早发冠心病与早发MI的独立危险因素,应重视FH的早期诊断与强化调脂治疗。

Objectives To observe the clinical characteristics of familial hypercholesterolemia(FH)and to explore its correlation with early myocardial infarction(MI). Methods Totally 5 584 patients with MI admitted to Sunshine Union Hospital from January 2000 to December 2018 were included in this retrospective analysis. The patients were divided into early-onset MI group and non-early-onset MI group according to the criteria of Dutch clinical lipid network(DLCN). The characteristics and prevalence of FH were compared between the two groups. The clinical characteristics were analyzed by Logistic multivariate regression analysis to summarize the effect of FH on early MI. Results Among the 5 584 patients,2 532 were early-onset MI and the rest 3 052 were non-early-onset MI. There were 252 patients diagnosed with FH,including 220 in early-onset MI group,32 in non-early-onset MI group. The prevalence of FH in early-onset MI group was 8.67%,higher than 1.05% in non-early-onset MI group,with significant difference(P<0.05). The age and body mass index(BMI)of FH group were lower than those of non-FH group,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG)of FH group were higher than those of nonFH group;the male proportion,prevalence of hypertension and diabetes of FH group were lower than those of non-FH group,and the proportion of family history of coronary heart disease was higher than that of non-FH group,the differences were statistically significant(P<0.05). Logistic multivariate regression analysis showed that FH was an independent risk factor for early MI after adjusting for traditional risk factors such as BMI,TC and HDL-C. Compared with non-FH patients,the risk of early MI in FH patients increased by 20.122 times(P<0.05). Conclusions FH is an independent risk factor for early coronary heart disease and early MI. Early diagnosis and intensive lipid-lowering therapy of FH should be emphasized.