骨质疏松症与冠心病共病患者的临床特征及其影响因素

Clinical characteristics and influencing factors in patients with osteoporosis complicated with coronary atherosclerotic heart disease

目的了解骨质疏松症(osteoporosis,OP)并发冠心病(coronary atherosclerotic heart disease,CAHD)患者的临床特征与影响因素,为两种疾病的防治和共病患者的临床决策与健康管理提供基础。方法2017年11月至2018年7月,在北京市朝阳区、丰台区10个社区收集居民临床信息、生物样本并进行骨密度检测,以OP患者是否并发CAHD分为并发CAHD组和未并发CAHD组,进行临床特征的差异性比较,并进一步对两类人群的影响因素进行单因素及多因素分析。结果并发CAHD组患者年龄高于未并发CAHD组,差异有统计学意义(P=0.02)。心血管疾病、脑血管疾病以及糖尿病家族史在并发CAHD组的出现比例远高于未并发CAHD组,差异有统计学意义(P<0.05)。此外,骨代谢标志物、体质量指数、双手握力、坐立试验、性别、婚姻状况、户口性质、文化程度、工作类型及家庭月收入等两组间比较差异均无统计学意义(P>0.05)。单因素相关性分析发现,高龄、家族疾病史(心血管病、脑血管病、糖尿病)、烹饪方式(爆炒)、蔬菜摄入、植物油均是社区OP患者并发CAHD的影响因素(P<0.05);多因素回归分析显示,高龄(OR=1.09)、心血管病家族史(OR=2.68)、糖尿病家族史(OR=2.15)以及蔬菜摄入频率(OR=4.13)是并发CAHD的独立影响因素(P<0.05)。结论社区居民"一体多病"现象日益凸显,预防或延缓不同疾病终点结局的发生,实现不同疾病管理的协调统一是最终目的;建议尽早明确患者临床特征及危险因素,或将有益于共病患者的共诊、共治与共管。

Objective To investigate the clinical characteristics and influencing factors of osteoporosis(OP) patients complicated with coronary atherosclerotic heart disease(CAHD),so as to provide the basis for the prevention and treatment of the two kinds of diseases.Methods From November 2017 to July 2018,clinical information and biological samples of residents in 10 communities in Chaoyang District and Fengtai District of Beijing were collected and bone mineral density(BMD)was detected.Patients with OP were divided into two groups according to whether they were complicated with CAHD.The differences of clinical characteristics were compared,and the influencing factors of the two groups were further analyzed by univariate and multivariate analysis.Results The patients with CAHD was older than those without CAHD,and the difference was statistically significant(P=0.02).The proportion of cardiovascular disease,cerebrovascular disease and family history of diabetes in the group with CAHD was higher than those in the group without CAHD,and the difference was statistically significant(P<0.05).In addition,there were no significant differences in body mass index,hand grip strength,sitting test,sex,marital status,nature of household registration,education level,type of work and monthly family income between the two groups(P>0.05).Univariate correlation analysis showed that age,family history of diseases(cardiovascular disease,cerebrovascular disease,diabetes),cooking style(stir-frying),vegetable intake,and vegetable oil were the influencing factors of patients with comorbidity.However,there were no significant differences in bone metabolic biomarkers,body mass index,hand grip strength,sitting test,sex,marital status,nature of household registration,education level,type of work,and monthly family income among the groups.Multivariate regression analysis showed that age(OR=1.09),family history of cardiovascular disease(OR=2.68),family history of diabetes(OR=2.15)and frequency of vegetable intake(OR=4.13)were independent influencing factors of CAHD.Conclusions The phenomenon of"multiple diseases in one body"among community residents is increasing prominently.Preventing or delaying the occurrence of endpoints and coordinate management of different diseases is the ultimate goal.It is suggested that the clinical characteristics and risk factors of patients should be identified as soon as possible.It may be beneficial to co-diagnosis,co-treatment,and co-management of patients with comorbidity.