中青年钙化性主动脉瓣疾病的特征及危险因素分析

Clinical characteristics and risk factors of young and middle-aged patients with calcified aortic valve disease

目的分析患钙化性主动脉瓣疾病的中青年患者的临床特征,探求导致此类人群发病的可能危险因素。方法将2020年1月至2020年3月在首都医科大学附属北京安贞医院心内科行经胸超声心动图检查及冠状动脉造影检查,年龄在18~59岁之间拟诊冠状动脉粥样硬化性心脏病(以下简称冠心病)的141例住院患者作为研究对象,分为病例组(钙化性主动脉瓣疾病者44例)和对照组(主动脉瓣正常者97例),对两组的基线资料及合并的致动脉粥样硬化危险因素进行观察性研究。结果与主动脉瓣正常的中青年相比,钙化性主动脉瓣疾病患者的总胆固醇浓度更高[(4.45±1.00)mmol/L vs(3.93±0.77)mmol/L,P=0.001]、低密度脂蛋白胆固醇更高[(2.73±0.76)mmol/L vs(2.42±0.68)mmol/L,P=0.016]、合并冠心病比例更高(100%vs 90.7%,P=0.03)。钙化性主动脉瓣疾病的中青年患者均存在致动脉粥样硬化危险因素。合并的致动脉粥样硬化危险因素越少,其吸烟、高血压、糖代谢异常占比越高。中青年患者钙化性主动脉瓣疾病危险因素的Logistic回归分析显示,高总胆固醇浓度是中青年发生钙化性主动脉瓣疾病的影响因素(P=0.007,OR=4.882,95%CI:1.553~15.347)。结论钙化性主动脉瓣疾病的中青年患者比同年龄段主动脉瓣正常者的总胆固醇及低密度脂蛋白胆固醇浓度更高,合并冠心病者更多,高总胆固醇可能是中青年发生钙化性主动脉瓣疾病的影响因素。

Objective To analyze the clinical characteristics of calcific aortic valve disease in the young and middle-aged patients and explore the possible risk factors in this population group.Methods A total of 141 patients with suspected coronary heart disease aged 18-59 who underwent transthoracic echocardiography and coronary angiography from January 2020 to March 2020 were enrolled in the Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University.Baseline data and associated atherosclerotic risk factors were observed in the patients with calcified aortic valve disease and patients with normal aortic valve.Results Compared with adults with normal aortic valves,the patients with calcified aortic valve disease had higher total cholesterol[(4.45±1.00)mmol/L vs(3.93±0.77)mmol/L,P=0.001],and lower density lipoprotein cholesterol[(2.73±0.76)mmol/L vs(2.42±0.68)mmol/L P=0.016],and the incidence of coronary heart disease was higher(100%vs 90.7%P=0.03).There are risk factors for atherosclerosis in the young and middle-aged patients with calcified aortic valve disease.The less the risk factors of atherosclerosis,the higher the proportion of smoking,hypertension and abnormal glucose metabolism.Logistic regression analysis of risk factors for calcified aortic valve disease in the young and middle-aged adults showed that high total cholesterol was the influencing factor for calcified aortic valve disease in the young and middle-aged adults(P=0.007,OR=4.882,95%CI:1.553-15.347).Conclusion The total cholesterol level and low density lipoprotein-cholesterol level of the young and middle-aged patients with calcified aortic valve disease were higher than those with normal aortic valve at the same age,and more patients with coronary heart disease.High total cholesterol level may be the influencing factor of calcified aortic valve disease in the young and middle-aged patients.