中国老年重度瓣膜性心脏病患者合并冠心病的危险因素分析:全国多中心横断面研究

Analysis of Risk Factors for Coronary Heart Disease in Elderly Chinese Patients with Severe Valvular Heart Disease:A National Multicenter Cross-sectional Study

目的 探讨中国老年重度瓣膜性心脏病(valvular heart disease,VHD)患者合并冠心病(coronary heart disease,CHD)的危险因素。方法 采取横断面研究,连续入选2021年9月至2022年3月在全国18家三甲医院诊断为老年重度VHD患者977例,其中合并CHD 291例(29.8%)纳入CHD组,其余686例患者纳入非CHD组。收集入选患者的临床资料和超声心动图数据,分析合并CHD的危险因素。结果 与非CHD组比较,CHD组患者合并高龄、高体重指数(body mass index,BMI)、吸烟史、高血压、高脂血症、糖尿病比例更高,血肌酐、糖化血红蛋白水平、男性比例更高,静息心率、低密度脂蛋白胆固醇水平、左室射血分数更低,差异均有统计学意义(P <0.05)。多因素logistic回归分析结果显示,高血压(OR=2.030、P <0.01)、高脂血症(OR=4.180、P <0.01)、糖化血红蛋白(OR=1.372、P <0.01)、左室射血分数(OR=0.975、P <0.01)是老年VHD合并CHD的独立危险因素。结论 在老年重度VHD群体中,CHD发生率较高,高血压、高脂血症、糖化血红蛋白、左室射血分数与CHD独立相关。对于合并有这些独立危险因素的重度VHD患者,术前应更加重视冠状动脉造影检查。

Objective To explore risk factors for combined coronary heart disease(CHD) in elderly Chinese patients with severe valvular heart disease(VHD).Methods In this cross-sectional study,977 elderly patients with severe VHD diagnosed in 18 tertiary hospitals across the country from September 2021 to March 2022 were consecutively enrolled.Of them,291(29.8%) patients with CHD were in the CHD group,the remaining 686 patients were in the non-CHD group.The clinical data and echocardiographic data were collected to analyze the risk factors of combined CHD.Results Compared with the non-CHD group,the CHD group had higher proportions of advanced age,higher BMI,smoking history,hypertension,hyperlipidemia,and diabetes,as well as higher serum creatinine,glycosylated hemoglobin and male ratios;resting heart rate,low-density lipoprotein cholesterol level,and left ventricular ejection fraction were lower,and the differences were statistically significant(P <0.05).Multivariate logistic regression analysis showed that hypertension(OR =2.030,P <0.01),hyperlipidemia(OR =4.180,P <0.01),glycosylated hemoglobin(OR =1.372,P <0.01),left ventricular ejection fraction(OR =0.975,P <0.01) were independent risk factors for elderly VHD complicated with CHD.Conclusions In the elderly with severe VHD,the incidence of CHD was higher,and hypertension,hyperlipidemia,glycosylated hemoglobin,and left ventricular ejection fraction were independently associated with CHD.For severe VHD patients with these independent risk factors,more attention should be paid to coronary angiography before surgery.