45岁以下青年女性冠心病患者的危险因素及预后分析

Risk factors and prognosis analysis of coronary heart diseases in young females below 45 years of age

目的:探讨青年女性患者发生冠心病的主要危险因素,并分析其预后。方法:回顾性分析我院2017年1月至2018年6月期间,拟诊为冠心病并接受冠状动脉造影(CAG)检查的18~44岁女性患者211例,根据CAG结果将其分为冠心病组(CHD组)115例和对照组96例,多因素Logistic回归分析其危险因素,受试者工作特征(ROC)曲线评价这些因素对青年女性发生冠心病的预测价值,CHD组患者出院后随访12个月,分析主要心血管不良事件(MACE)发生率。结果:多因素Logistic回归结果提示高血压(OR=2.721,95%CI=1.376~5.380,P=0.004)和早发CHD家族史(OR=3.580,95%CI=1.109~11.554,P=0.033)是青年女性发生冠心病的危险因素,HDL-C是保护性因素(OR=0.074,95%CI=0.022~0.250,P<0.001)。ROC曲线显示HDL-C预测青年女性冠心病的曲线下面积为0.705,按截断值1.045 mmol/L将CHD组患者分为两组,随访12个月时,低HDL-C组和高HDL-C组MACE的发生率分别为14.8%和8.7%,差异无统计学意义。结论:高血压和早发CHD家族史是青年女性冠心病的危险因素,HDL-C具有保护效应,对冠心病的发生有一定预测价值。

Objective: To investigate risk factors and prognosis of coronary heart diseases(CHD) in young women aged less than 45 years old. Methods: Between January 2017 and June 2018, a total of 211 young females(18~44 years old) who underwent coronary angiography(CAG) in our hospital were retrospectively analyzed. 115 women with angiographically confirmed CHD were enrolled into the experiment group and 96 women without CHD served as the control group. Risk factors were identified by Logistic regression analysis and receiver operating characteristic(ROC) curve was performed to evaluate the predictive values for CHD. Prognosis was compared by major adverse cardiovascular events(MACE) after follow-up for 12 months. Results: Logistic multivariate regression showed that hypertension(OR=2.721, 95%CI=1.376-5.380, P=0.004) and family history for early-onset CHD(OR=3.580, 95%CI=1.109-11.554, P=0.033) were independent risk factors for CHD in young females, while high density lipoprotein-cholesterol(HDL-C) acted as a protective factor(OR=0.074, 95%CI=0.022-0.250, P<0.001). Additionally, the area under the ROC curve of HDL-C for predicting CHD was 0.705 and patients in the CHD group were divided into low HDL-C group and high HDL-C group according to cut-off value(1.045 mmol/L). At 12-month follow-up, the incidence of MACE in the low HDL-C group and high HDL-C group 14.8% and 8.7% respectively, although no significant difference was observed. Conclusions: In young females, both hypertension and family history for early-onset CHD were independent risk factors for the presence of CHD. HDL-C should be regarded as a protective factor which could predict CHD occurrence.