女性生育次数及教育程度与冠心病的相关性研究

The correlation between the number of birth, educational level and coronary heart disease among the women population

目的探讨女性生育次数及教育程度与冠心病、冠状动脉病变支数的相关性。方法采用回顾性病例对照研究,纳入2017年1月至6月就诊于新疆医科大学第一附属医院,初次行冠状动脉造影检查的女性563例,平均年龄(61.97±9.18)岁。分析患者一般资料、生育次数及受教育程度的差异性,并通过logistic多因素分析观察上述因素与女性冠心病及冠状动脉病变支数是否相关。结果根据冠状动脉造影结果分为冠心病组(360例)和正常组(203例),冠心病组患者年龄,高血压病、糖尿病、绝经比例,生育次数、文化程度构成比,低密度脂蛋白胆固醇及收缩压均显著大于正常组,而左心室射血分数、高密度脂蛋白胆固醇水平显著低于正常组,差异均有统计学意义(均P<0.05)。根据冠状动脉支数分为单支病变组(159例)、双支病变组(73例)和左主干/三支病变组(128例),三组患者年龄,高血压病、糖尿病、绝经比例,高密度脂蛋白胆固醇水平、左心室射血分数,文化程度、生育次数构成比比较,差异均有统计学意义(均P<0.05)。以生育次数进行分组,分为≤1次组(131例)、2次组(165例)、3次组(109例)及≥4次组(158例),四组患者体重指数、高密度脂蛋白胆固醇水平和高血压病、糖尿病、冠心病比例比较,差异均有统计学意义(均P<0.05)。二分类logistic多因素分析显示,年龄每增加1岁,冠心病发生的危险性增加4.1%(OR 1.041,95%CI 1.014~1.070,P=0.003),高血压病患者患冠心病风险增加2.170倍(OR 2.170,95%CI 1.465~3.215,P<0.001),糖尿病患者增加2.672倍(OR 2.672,95%CI 1.573~4.539,P<0.001),低密度脂蛋白胆固醇每增加1 mmol/L,冠心病风险增加69.5%(OR 1.695,95%CI 1.310~2.193,P<0.001);而文化程度及生育次数与冠心病的发病无相关性。有序logistic多因素分析显示,糖尿病(OR 2.171,95%CI 1.542~3.056,P=0.001)与冠状动脉病变支数呈正相关,而高密度脂蛋白胆固醇(OR 0.313,95%CI 0.148~0.663,P=0.002)是冠状动脉病变支数的保护因素;大学文化程度的患者相比于文盲患者,冠状动脉病变支数至少低一个等级的可能性,为0.367倍(OR 0.367,95%CI 0.140~0.961,P=0.041);生育次数与女性冠心病的发病无直接关系。结论生育次数与女性冠心病发病无直接相关性,受教育程度与冠心病冠状动脉病变支数呈负相关性。

Objective To explore the correlation between the number of births and the educational level with coronary heart disease(CHD)and the number of lesion branches of coronary artery in women.Methods A retrospective case-control study was conducted.The number of female patients who visited First Affi liated Hospital of Xinjiang Medical University underwent coronary angiography at the fi rst time from January to June in 2017 were 563,the average age was(61.97±9.18)years old.The diff erences of general information,number of births and education level of the patients were analyzed,and multivariate logistic regression analysis was used to analyze whether these were risk factors for CHD and the number of lesion branches of coronary artery in women.Results According to coronary angiography were divided into coronary heart disease group(n=360)and normal group(n=203).The age,hypertension,diabetes,menopause ratio,the number of birth,education level,LDL-C and systolic blood pressure of patients in CHD group were signifi cantly higher than those in the control group,while the left ventricular ejection fraction(LVEF),HDL-C were signifi cantly lower than that in the control group(all P<0.05).According to the number of coronary artery branches,the patients were divided into single vessel lesion group(159 cases),double vessel lesion group(73 cases)and left main/three vessel lesion group(128 cases).There were statistically significant differences among the three groups constituent ratio in age,hypertension,diabetes,menopause,HDL-C,LVEF,education level and the number of births(all P<0.05).According to the number of births,the patients were divided into four groups:≤1 time group(131 cases),two times group(165 cases),three times group(109 cases)and≥4 times group(158 cases).There were significant differences in BMI,HDL-C,hypertension,diabetes and CHD among the four groups of patients(all P<0.05).Two-category logistic multivariate analysis showed that the risk of CHD increased by 4.1%for every 1-year increase in age(OR 1.041,95%CI 1.014–1.070,P=0.003),and 2.170 times in patients with hypertension(OR 2.170,95%CI 1.465–3.215,P<0.001),and 2.672 times in patients with diabetes(OR 2.672,95%CI 1.573–4.539,P<0.001).For every 1 mmol/L increase in LDL-C,the risk of CHD increases by 69.5%(OR 1.695,95%CI 1.310–2.193,P<0.001).Ordinal logistic multivariate analysis showed that diabetes was positively correlated with the number of coronary artery lesions(OR 2.171,95%CI 1.542–3.056,P=0.001),and HDL-C was a protective factor for the number of coronary artery lesions(OR 0.313,95%CI 0.148–0.663,P=0.002).Compared with illiterate patients,college-educated patients were 0.367 times likely to have at least one grade of coronary arterial disease count(OR 0.367,95%CI 0.140–0.961,P=0.041).Conclusions The number of births was not an independent risk factor for CHD,Educational attainment was inversely associated with number of lesion branches of coronary artery.