年轻人群（年龄≤40岁）中与冠状动脉疾病相关的因素：217例病例分析

Factors associated with coronary artery disease in young population (age ≤ 40): analysis with 217 cases.

作者信息

Yang Wei-xian, Yang Zheng, Wu Yong-jian, Qiao Shu-bin, Yang Yue-jin, Chen Ji-Lin

机构信息

Coronary Heart Disease Department, Fuwai Hospital, Beijing 100037, China;

Department of Cardiology, China Meitan General Hospital, Beijing 100028, China.

出版信息

Chin Med Sci J. 2014 Mar;29(1):38-42. doi: 10.1016/s1001-9294(14)60022-5.

DOI:10.1016/s1001-9294(14)60022-5

PMID:24698677

Abstract

OBJECTIVE

To investigate the relevant factors of coronary artery disease (CAD) in young people under 40 years of age.

METHODS

The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7 ± 3.7 years. The diagnosis of CAD was made in the cases presenting ≥ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients (204 men, 13 women) were assigned to CAD group, and 75 (68 men, 7 women) to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, χ² test, and multinomial logistic regression with SPSS 8.0 software.

RESULTS

Most study subjects were current smokers (209/292, 71.6%), and more than half had body mass index (BMI)>24 kg/m² (230/292, 78.8%) and usually took high-fat diet (162/292, 55.5%). The proportion of heavy smokers (smoking history ≥ 10 years and ≥ 20 cigarettes per day) were significantly higher in the CAD group than in the non-CAD group [20.7% (45/217) vs. 9.3% (7/75), P=0.015)]. Heavy smoking [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.74-2.05], hypertension (OR, 1.56; 95% CI, 1.48-1.65), alcohol (OR, 1.37; 95% CI, 1.30-1.46), type 2 diabetes mellitus (OR, 1.37; 95% CI, 1.25-1.50), high-fat diet (OR, 1.35; 95% CI, 1.28-1.43), and BMI>24 kg/m² (OR, 1.09; 95% CI, 1.03-1.17) were factors related to CAD in the young patients (all P<0.05). Total cholesterol (4.56 ± 1.46 mmol/L vs. 4.09 ± 1.00 mmol/L), low-density lipoprotein cholesterol (2.38 ± 1.11 mmol/L vs. 2.14 ± 0.63 mmol/L), lipoprotein a (134.97 ± 109.70 mg/L vs. 101.58 ± 58.39 mg/L), uric acid (359.89 ± 100.09 μmol/L vs. 336.75 ± 94.36 μmol/L), erythrocyte sedimentation rate (9.98 ± 12.19 mm/hour vs. 4.89 ± 4.92 mm/hour), high-sensitivity C-reactive protein (3.42 ± 4.39 mg/L vs. 2.80 ± 3.77 mg/L) and Big endothelin-1 (1.41 ± 1.50 fmol/mL vs. 0.77 ± 1.13 fmol/mL) in plasma were significantly increased in the CAD group compared with the non-CAD group (all P<0.05).

CONCLUSIONS

Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI>24 kg/m² were significantly related to CAD in patients aged ≤ 40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.

摘要

目的

探讨40岁以下年轻人冠心病（CAD）的相关因素。

方法

研究对象为2006年7月至12月在阜外医院接受冠状动脉造影的292例年轻患者，其中男性272例，女性20例，平均年龄为36.7±3.7岁。冠状动脉造影显示冠状动脉管腔狭窄≥50%的病例诊断为CAD。根据诊断结果，将217例患者（204例男性，13例女性）分为CAD组，75例（68例男性，7例女性）分为非CAD组。收集患者的临床资料和代谢特征，并使用SPSS 8.0软件进行t检验、χ²检验和多项逻辑回归分析。

结果

大多数研究对象为当前吸烟者（209/292，71.6%），超过一半的人体重指数（BMI）>24 kg/m²（230/292，78.8%），且通常食用高脂饮食（162/292，55.5%）。CAD组中重度吸烟者（吸烟史≥10年且每天≥20支香烟）的比例显著高于非CAD组[20.7%（45/217）对9.3%（7/75），P = 0.015]。重度吸烟[比值比（OR），1.89；95%置信区间（CI），1.74 - 2.05]、高血压（OR，1.56；95% CI，1.48 - 1.65）、饮酒（OR，1.37；95% CI，1.30 - 1.46）、2型糖尿病（OR，1.37；95% CI，1.25 - 1.50）、高脂饮食（OR，1.35；95% CI，1.28 - 1.43）和BMI>24 kg/m²（OR，1.09；95% CI，1.03 - 1.17）是年轻患者CAD的相关因素（均P<0.05）。与非CAD组相比，CAD组血浆总胆固醇（4.56±1.46 mmol/L对4.09±1.00 mmol/L）、低密度脂蛋白胆固醇（2.38±1.11 mmol/L对2.14±0.63 mmol/L）、脂蛋白a（134.97±109.70 mg/L对101.58±58.39 mg/L）、尿酸（359.89±100.09 μmol/L对336.75±94.36 μmol/L）、红细胞沉降率（9.98±12.19 mm/小时对4.89±4.92 mm/小时）、高敏C反应蛋白（3.42±4.39 mg/L对2.80±3.77 mg/L）和大内皮素-1（1.41±1.50 fmol/mL对0.77±1.13 fmol/mL）均显著升高（均P<0.05）。