大动脉炎合并冠心病的临床特点和危险因素分析

Clinical features of coronary artery disease complicating Takayasu arteritis and analysis of the risk factors

目的探讨大动脉炎(TA)合并冠心病(CAD)的临床特点并分析其危险因素。方法回顾性分析2012年1月至2019年3月在北京安贞医院风湿免疫科住院的TA患者101例,分为TA合并CAD组28例和TA不合并CAD组73例。比较两组患者的一般资料、临床特点和预后情况,并采用logistic回归分析TA合并CAD的危险因素。结果与TA不合并CAD患者比较,合并CAD的TA患者年龄较大[(44.7±13.3)岁vs.(38.7±10.8)岁,P<0.05]、TA发病年龄>40岁比例较高(42.9%vs. 16.4%,P<0.01),血清三酰甘油较高[(1.89±1.29)mmol/L vs.(1.17±0.73)mmol/L,P<0.01]。logistic回归表明TA发病年龄大于40岁(OR 3.235,95%CI 1.028~10.181,P=0.045)和血清三酰甘油(OR 2.121,95%CI 1.164~3.862,P=0.014)是TA合并CAD的独立危险因素。Log-rank检验表明合并CAD的TA患者出院后1年的主要不良心脑血管事件发生率较高(χ^(2)=6.875,P=0.009)。结论发病年龄大于40岁、血清三酰甘油较高的TA患者较易合并CAD,合并CAD的TA患者远期预后较差。

Objective To explore the clinical features of coronary artery disease(CAD)complicating Takayasu arteritis(TA)and analyze the risk factors. Methods A retrospective analysis was performed on 101 TA patients,who were admitted to Rheumatology and Immunology Department,Beijing Anzhen Hospital,from January 2012 to March 2019,and they were divided into TA with CAD group(n=28)and TA without CAD group(n=73). General information,clinical features and prognosis were compared between the two groups,and the risk factors of CAD complicating TA were analyzed by logistic regression analysis. Results Compared to TA patients without CAD,age[(44.7 ± 13.3)years vs.(38.7 ± 10.8)years,P<0.05)],the proportion of patients with TA-onset age >40 years(42.9% vs. 16.4%,P<0.01),and serum triglyceride level[(1.89±1.29)vs.(1.17±0.73)mmol/L,P<0.01]were higher in TA patients with CAD. The logistic regression analysis showed that TA-onset age>40 years and serum triglyceride level were independent risk factors for CAD in TA(OR 3.235,95% CI 1.028~10.181,P=0.045;OR 2.121,95% CI 1.164~3.862,P=0.014). Log-rank test showed that TA patients with CAD were more likely to experience major adverse cardiac and cerebrovascular events during 1-year follow-up(χ^(2)=6.875,P=0.009). Conclusions TA patients with onset age over 40 years old and higher serum triglyceride level are more likely to have CAD,and those with CAD are more likely to have a worse long-term prognosis.