北京地区汉族冠心病患者的脂联素水平与冠心病临床特点及预后关系的分析

【作者】 李全；

【导师】 严晓伟； 范中杰； 黎明； 方理刚；

【作者基本信息】 中国协和医科大学 ， 内科学， 2010， 博士

【摘要】 背景：据报道冠心病(coronary artery disease, CAD)患者冠心病危险因素具有民族及地区的差异性,而这些危险因素与冠状动脉病变的严重程度具有一定的相关性。近年来新发现的冠心病危险因素中,较多研究均支持低脂联素血症与冠心病及冠心病危险因素具有一定的相关性,并且脂联素具有种族特异性。目的：研究北京地区汉族冠心病患者的冠心病危险因素的特点及临床表现,探讨脂联素(adiponectin, APN)水平与冠心病危险因素的关系,APN和冠心病患者的主要心脑血管不良事件的关系。材料和方法：以2007年7月至2009年5月在北京协和医院因胸痛住院行冠脉造影检查的北京地区汉族患者为研究对象,共收集503例,对其中明确诊断冠心病的患者进行临床随访,随访截止日期2010年3月17(最长随访31月,最短1月,平均随访19月)。就诊住院当日,所有患者均收集其一般信息、冠心病危险因素以及既往患病信息等,并采集静脉血检测空腹静脉血浆葡萄糖、血脂、APN等指标,并行冠状动脉造影检查。同时评估调查对象的肌酐清除率(Creatinine clearance Ccr)、左室射血分数等临床特点,符合冠心病诊断标准的研究对象纳入随访观察,记录终点事件发生情况。终点事件主要指心脑血管主要不良事件(major adverse cardiac and cerebral vascular events, MACCE),它的具体内容包括心源性死亡、非心源性死亡、靶血管病变重建、随访期间发生的心肌梗死、脑卒中或者一过性脑缺血、需要住院治疗的不稳定心绞痛和心功能衰竭,其中不稳定心绞痛和心肌梗死并为急性冠脉综合症。分析冠心病危险因素与冠脉狭窄程度及冠脉积分的关系；探讨冠心病患者预后的影响因素及脂联素水平对冠心病患者预后的价值。结果：1、北京地区汉族冠心病患者人群中,男性[P＜0.01, OR=2.648,95%CI(1.494-4.692)]、2型糖尿病[P＜0.01, OR=2.399,95%CI (1.251-4.602)]、吸烟[P＜0.01, OR=4.441,95%CI (1.356-14.548)]为其冠心病主要危险因素。2、通过冠脉积分对冠心病患者冠脉病变的严重程度与传统的心血管疾病危险因素分析得出,男性、2型糖尿病及高血压病与冠脉病变严重程度相关(P<0.01)。3、与对照组比较,冠心病患者可以伴随左室射血功能减退[P<0.01,95%CI(0.874-5.829)],肾脏功能下降[P<0.01,95%CI(5.137-17.594)],超敏C反应蛋白(HsCRP)水平升高[P<0.01,95%CI(1.298-3.013)],而且这些参数变化与冠脉病变严重程度相关。4、冠心病患者的MACCE发生与冠脉狭窄程度[P<0.05,95%CI(3.973-19.401)]、超声左室射血分数[P<0.01,95%CI(0.859-2.523)]及HsCRP水平[P<0.01,95%CI(1.342-6.219)]具有一定的相关性。5、APN水平与冠心病多种危险因素具有相关性,多元回归分析显示低APN血症的冠心病患者出现MACCE的风险增高, (RR=0.43,P<0.05),且不受冠心病传统危险因素、临床特点及冠脉病变严重程度的影响。结论：1、在传统的冠心病危险因素中,吸烟、男性及2型糖尿病与北京地区汉族冠心病患者联系更加紧密,而且心肾功能下降和HsCRP水平升高与冠脉病变严重程度具有一定相关性。2、低APN血症和与多个冠心病危险因素具有相关性,是冠心病患者预后的较好的预测因子。更多还原

【Abstract】 BackgroundThe importance of different cardiovascular risk factors varies among different countries and ethnicities, which are also associated with degree of coronary artery severity. Hypoadiponectinemia has been reported to be associated with cardiovascular disease and cardiovascular risk factors, and plasma adiponectin level is different among different ethnicitiesObjectiveTo analyse distribution characteristics of cardiovascular risk factors and clinical characteristics within patients with coronary artery disease in Beijing Han. To explore the relationship between adiponectin level and cardiovascular risk factors, and to investigate the relationship between adiponectin and prognosis of cardiovascular diseases, especially coronary artery disease.Design and methodA total of 503 hospitalized patients undergoing coronary angiography, who were Beijing Han, from July 2007 to May 2009 in Peking Union Medical College Hostipal were included. All patients’ clinical data, including classic cardiovascular risk factors, creatinine clearance, left ventricle ejection fraction were recorded after admission and those with cardiovascular disease were followed up till March 17, 2010(1month to 31monthes). The primary end point was the combined occurrence of major adverse cardiovascular cerebral vascular events(MACCE), including cardiovascular death, non-cardiovascular death, targeted vascular revascularization, myocardial infarction, rehospitalization due to unstable angia and heart failure, transient ischemic attack and stroke. And analysis was conducted to identify the relationships among risk factors, coronary artery disease and coronary score. Exploration was made to find the relationship between the plasma adiponectin level and the MACCE and the factors influencing prognosis.Results 1, Among Beijing Han patients with coronary artery disease, male gender[P<0.01, OR 2.648,95%CI (1.494-4.692)],2-DM[P<0.01, OR 2.399,95%CI (1.251-4.602)], smoke[P<0.01, OR 4.441,95%CI (1.356-14.548)] are associated with coronary artery disease.2, Compared with other classic cardiovascular risk factors, coronary artery severity degree is associated with male,2-DM and hypertension by ways of coronary score systems (P＜0.01)3, The patients with coronary artery disease was accompanied with reduced left ventricular ejection fraction[P<0.01,95%CI (0.874-5.829)], reduced renal function[P<0.01,95%CI (5.137-17.594)], and elevated HsCRP level, which were associated with degree of coronary artery severity.4, The risk of MACCE is associated with stenosis of coronary artery[P<0.01,95%CI (3.973-19.401)], left ventricular ejection fraction[P<0.01,95%CI (0.859-2.523)] and the level of HsCRP[P<0.01,95%CI (1.342-6.219)].5, Plasma adiponectin level is associated with classic cardiovascular risk factors. Multiple regression analysis shows adiponectin is associated with risk of MACCE (RR=0.43, P<0.05), which is not influenced by classic cardiovascular risk factors and degree of coronary artery severity.Conclusion1, Among classic cardiovascular risk factors, smoke, male and 2-DM are more closed to coronary artery disease within Beijing Han. Those patients were accompanied with impaired cardiac and renal function and elevated HsCRP level, which were associated with degree of coronary artery severity.2, Adiponectin is associated with classic cardiovascular risk factors, and it is an indepent predictor of prognosis of coronary artery disease.更多还原