高原地区因胸痛就诊的藏族人群罹患冠心病的危险因素分析

Analysis of coronary risk factors in Tibetans at high altitude

目的分析西藏高原地区因胸痛就诊的藏族人群罹患冠心病(coronary heart disease,CHD)的危险因素。研究对象连续入选2009年1月至2017年12月因胸痛症状就诊于西藏自治区人民医院心血管内科,行诊断性冠状动脉造影检查的长期居住在高原地区的藏族患者467例。干预措施CHD定义为造影证实至少1支心外膜主要血管(包括左主干、左前降支、回旋支和右冠状动脉)及其主要分支上存在直径狭窄程度≥50%的病变,根据最终诊断分为CHD组和非CHD组2组,采用多因素Logistic分析识别西藏高原地区藏族人群罹患CHD的危险因素。观测指标及测量方法回顾性收集社会人口学特征指标,包括性别、年龄、民族、体重指数,既往病史包括高血压、高脂血症、糖尿病、目前吸烟、高原红细胞增多症、周围动脉疾病、脑血管疾病和早发冠心病家族史;实验室检测指标包括红细胞、血红蛋白、血小板、纤维蛋白原、高密度脂蛋白胆固醇(high densitylipoprotein cholesterol,HDL‑C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL‑C)、总胆固醇、甘油三酯、血尿酸;冠状动脉造影发现的影像学特征如冠状动脉狭窄程度等。其中实验室检测指标采用中心实验室检测,冠状动脉狭窄程度的判断采用目测直径法。结果接受诊断性冠状动脉造影检查的467例患者中,最终诊断为CHD的患者共283例。多因素Logistic回归分析显示,年龄大[比值比(odds ratio,OR)=1.052,95%置信区间(confidence interval,CI)为1.028~1.077,P<0.001)、男性(OR=2.511,95%CI为1.325~4.760,P=0.005)、目前吸烟(OR=2.812,95%CI为1.741~4.541,P<0.001)、纤维蛋白原升高(OR=1.400,95%CI为1.143~1.716,P=0.001)、HDL‑C降低(OR=0.261,95%CI为0.116~0.588,P=0.001)、LDL‑C升高(OR=1.365,95%CI为1.049~1.776,P=0.020)是CHD的主要危险因素。高原红细胞增多症(OR=0.220,95%CI为0.107~0.449,P<0.001)与CHD呈负相关。结论在高原地区因胸痛就诊的藏族患者人群中,高龄、男性、目前吸烟、HDL‑C降低、纤维蛋白原升高和LDL‑C升高者是冠心病的危险因素。

Objective To investigate coronary heart disease(CHD)risk factors in Tibetans at high altitudes.Participants This study was conducted in Tibet Autonomous Region People′s Hospital from January 2009 to December 2017,467 consecutive Tibetans who underwent diagnostic coronary angiography due to chest pain were enrolled.Interventions CHD was defined as the presence of≥50%luminal diameter stenosis in at least one major epicardial vessel,including the left main,left anterior descending artery,circumflex,and right coronary artery,or its major branches,by visual angiographic assessment.Patients were divided into the CHD and non‑CHD groups according to the final diagnosis.Multivariate logistic analysis was used to identify CHD risk factors.Main Outcomes and Measurements Retrospectively collected baseline demographic characteristics including sex,age,nationality,body mass index.Previous medical history included hypertension,hyperlipidemia,diabetes,current smoking status,high altitude polycythemia,peripheral arterial disease,cerebrovascular disease,and premature CHD family history.Laboratory tests included red blood cell,hemoglobin,platelet,fibrinogen,high‑density lipoprotein cholesterol(HDL‑C),low‑density lipoprotein cholesterol(LDL‑C),total cholesterol,triglyceride,and uric acid.Angiography assessed diameter stenosis.The assays were tested at the central laboratory,and the degree of coronary artery stenosis was assessed by angiographic visual diameter estimation.Results Among the 467 patients reviewed,283 were diagnosed with CHD.Multivariate logistic analysis showed that older age(OR=1.052,95%CI:1.028-1.077,P<0.001),male(OR=2.511,95%CI:1.325-4.760,P=0.005),smoking(OR=2.812,95%CI:1.741-4.541,P<0.001),higher fibrinogen level(OR=1.400,95%CI:1.143-1.716,P=0.001),lower HDL‑C level(OR=0.261,95%CI:0.116-0.588,P=0.001)and higher LDL‑C level(OR=1.365,95%CI:1.049-1.776,P=0.020)were the main predictors of CHD.However,high‑altitude polycythemia(OR=0.220,95%CI:0.107-0.449,P<0.001)negatively correlated with CHD.Conclusions In high‑altitude areas,CHD is more likely to occur in older male Tibetans with higher fibrinogen levels,lower HDL‑C levels,higher LDL‑C levels,and smokers.