老年冠心病病人血脂达标率及其影响因素的研究

Study on success rate of blood lipid and its influencing factors in elderly patients with coronary heart disease

目的了解规律行二级预防的老年CHD病人血脂达标率情况,并进一步探讨与其相关的影响因素。方法纳入2017年1月至2018年1月期间我院收治入院的,均已确诊CHD 1年以上且规范行二级预防的老年病人450例。收集病人的临床资料,包括性别、年龄、CHD病程、既往病史、实验室检查结果、LVEF等并进行整理分析。依据指南将病人分别按照LDL-C<1.8 mmol/L和非HDL-C<2.6 mmol/L为达标分组,对可能影响达标率的因素进行单因素和多因素分析。结果本研究中有192例(42.67%)病人LDL-C水平达标;有274(60.89%)例非HDL-C水平达标。在单因素分析过程中,影响LDL-C达标率和非HDL-C达标率的因素均为性别、DM、DM病程、血糖控制不住,及TC、TG、血糖水平(P<0.05)。性别、DM和血糖控制不佳在多因素回归分析中仍是影响LDL-C达标的因素;影响非HDL-C达标的多因素回归分析结果为性别和血糖控制不佳。结论已行二级预防的老年CHD病人的血脂达标率较高,性别和血糖控制不住是影响老年CHD病人血脂达标率的主要因素。

Objective To understand the success rate of blood lipid among the elderly patients with coronary heart disease(CHD)undergoing secondary prevention regularly and to explore the risk factors.Methods This study enrolled 450 elderly patients who were diagnosed with CHD for more than one years during January 2017 to January 2018,and regularly received the secondary prevention of CHD.The patients’characteristics,including gender,age,course of CHD,medical history(hypertension,diabetes),laboratory results such as total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non-high-density lipoprotein cholesterol(N-HDL-C),fasting plasma glucose(FPG),creatinine,glycosylated hemoglobin,examination results(coronary angiography,cardiac ultrasound,carotid ultrasound)were collected and analyzed.The patients were divided into eligible group and ineligible group according to the guidelines,whether LDL-C was<1.8 mmol/L or N-HDL-C was<2.6 mmol/L.The risk factors of the success rate of blood lipid were analyzed by univariate analysis and multivariate analysis.Results Among the 450 elderly patients with CHD,192(42.6%)patients achieved the target level of LDL-C,while 274(60.89%)patients achieved the target level of N-HDL-C.The univariate analysis showed that the influencing factors of the LDL-C and N-HDL-C success rate were gender,diabetes,serum glucose level and poor glucose control(P<0.05).In multivariate regression analysis,gender,diabetes and poor glucose control were independent factors that influenced LDL-C success rate,and gender and poor glucose control were influencing factors of N-HDL-C success rate.Conclusions The elderly patients with CHD undergoing second prevention have higher success rate of serum lipid.Gender and diabetes are the main factors affecting the serum lipid success rate in the elderly patients with CHD.