高海拔地区冠状动脉粥样硬化性心脏病患者冠状动脉病变的相关因素

Related factors of coronary artery disease in patients with coronary heart disease in high altitude areas

目的探讨高海拔地区冠状动脉粥样硬化性心脏病(冠心病)的危险因素,并分析影响冠心病患者冠状动脉病变程度的相关因素。方法选取2018年2月至2019年8月因胸痛在青海省心脑血管病专科医院住院治疗并行冠状动脉造影检查的患者516例为研究对象,根据冠状动脉造影检查结果分为冠心病组(n=304)和非冠心病组(n=212)。采用Gensini评分对冠心病患者冠状动脉病变程度进行分级,将冠心病组患者分为低分组(n=156)、中分组(n=86)和高分组(n=62)。比较冠心病组和非冠心病组患者、不同冠状动脉病变程度组患者的一般临床资料,并分析影响冠心病和冠状动脉病变程度的危险因素。结果冠心病组患者在男性患者比例、吸烟史、合并原发性高血压(高血压)、空腹血糖浓度、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)浓度明显高于非冠心病组患者,高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)和载脂蛋白A浓度明显低于非冠心病组患者,差异有统计学意义(P<0.01)。Logistic回归分析结果显示合并高血压、空腹血糖浓度增高、LDL-C浓度增高属于冠心病的独立危险因素,HDL-C、载脂蛋白A属于冠心病的保护因素。不同冠状动脉病变程度组患者年龄、空腹血糖浓度、LDL-C和HDL-C浓度比较,差异有统计学意义(P<0.01)。Logistic回归分析结果显示年龄、空腹血糖浓度、LDL-C浓度增高属于冠状动脉病变的独立危险因素,HDL-C属于冠状动脉病变的保护因素。结论在高原地区,伴随年龄的增大、空腹血糖浓度增高和LDL-C浓度增高是冠心病患者冠状动脉病变程度加重的危险因素,而HDL-C是高海拔地区冠心病患者冠状动脉病变程度的保护因素。

Objectives To investigate the risk factors of coronary heart disease(CHD)in high altitude areas and analyze the related factors affecting the degree of coronary artery lesions in patients with CHD.Methods Totally 516 patients performed coronary artery angiography for chest pain who were hospitalized in Qinghai Provincial Cardiovascular and Cerebrovascular Specialized Hospital from February 2018 to August 2019 were selected as the research objects.According to the result of coronary angiography,the patients were divided into CHD group(n=304)and non-CHD group(n=212).Using the Gensini score for coronary artery lesion severity classification,the patients in coronary heart disease group were divided into low score group(n=156),middle score group(n=86)and high score group(n=62).Clinical data of CHD group and non-CHD group,different coronary artery lesion severity group were compared.Influencing factors of coronary heart disease and coronary artery lesion severity were analyzed.Results The proportions of male patients,smoking history,combined hypertension and concentrations of fasting blood glucose,low-density lipoprotein cholesterol(LDL-C)were significantly higher in CHD group than those in non-CHD group(P<0.01),while concentrations of high-density lipoprotein cholesterol(HDL-C)and apolipoprotein A in CHD group were significantly lower than those in non-CHD group(P<0.01).Logistic regression analysis showed that combined hypertension,increasing concentration of fasting blood glucose and LDL-C were independent risk factors for CHD,while HDL-C and apolipoprotein A were protective factors for CHD.Age,concentrations of fasting blood glucose,LDL-C and HDL-C of CHD patients in the three different coronary artery lesion severity groups were statistically significant(P<0.01).Logistic regression analysis showed that age,increasing concentration of fasting blood glucose and LDL-C were independent risk factors for coronary artery disease,while HDL-C was a protective factor for coronary artery disease.Conclusions In the plateau region,increasing age,fasting glucose and LDL-C concentration are risk factors for aggravating the degree of coronary artery disease in patients with CHD,while HDL-C is a protective factor for the degree of coronary artery disease in patients with CHD.