【作者】 邱蕾；

【导师】 陈焕芹；

【作者基本信息】 山东大学 ， 老年医学， 2008， 硕士

【摘要】 目的:探讨冠心病危险因素与冠状动脉病变特点之间的相互关系。方法:收集我院2000年1月-2007年12月行冠状动脉造影病例2513例,其中确诊冠心病1866例,排除冠心病诊断647例。对各病例的冠心病危险因素、临床类型和冠脉病变特点进行回顾性的研究。从冠脉狭窄程度、Gensini积分、累及血管支数、弥漫性病变以及左前降支、左回旋支、右冠状动脉、左主干四支主要血管的病变情况来分析其与危险因素和临床类型的相互关系。结果:①冠心病与年龄、收缩压、空腹血糖、糖尿病病程、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B、脂蛋白(a)、总胆红素、尿酸相关(P＜0.01)。②男性、吸烟、超重、年龄、空腹血糖、总胆红素、间接胆红素与冠脉狭窄程度正相关(P＜0.01或P＜0.05)。③男性Gensini积分与年龄、高密度脂蛋白胆固醇、空腹血糖、体重指数和脂蛋白(a)相关(P＜0.01或P＜0.05);回归方程为:男性Gensini积分=-43.419+0.999年龄-25.686高密度脂蛋白+3.137空腹血糖+2.051体重指数+0.464脂蛋白(a)。女性Gensini积分与空腹血糖、总胆固醇、纤维蛋白原和脂蛋白(a)有关(P＜0.01或P＜0.05);回归方程为:女性Gensini积分=-126.860+3.604空腹血糖+7.639纤维蛋白原+6.984脂蛋白(a)+4.667总胆固醇。④糖尿病、高血压、超重、年龄、空腹血糖、纤维蛋白原与冠脉病变血管支数正相关(P＜0.01或P＜0.05),高密度脂蛋白胆固醇、载脂蛋白A与病变血管支数负相关(P＜0.01)。⑤糖尿病、超重、年龄、空腹血糖、载脂蛋白B、脂蛋白(a)、直接胆红素、纤维蛋白原与弥漫性病变正相关(P＜0.01或P＜0.05)。高密度脂蛋白胆固醇与弥漫性病变负相关(P＜0.01)。⑥男性、合并糖尿病、吸烟、超重与左前降支狭窄程度相关(P＜0.01或P＜0.05)。⑦合并糖尿病、超重、高密度脂蛋白胆固醇、空腹血糖和载脂蛋白A在不同左回旋支狭窄程度组间明显不同,且高密度脂蛋白胆固醇和载脂蛋白A随着左回旋支狭窄程度加重而降低(P＜0.01),而空腹血糖、超重比例随着左回旋支狭窄程度加重而增高(P＜0.01)。⑧合并高血压、糖尿病、超重、高密度脂蛋白胆固醇在不同右冠脉狭窄程度组间明显不同,且高密度脂蛋白胆固醇随着右冠脉狭窄程度加重而降低(P＜0.01)。⑨男性冠心病发病年龄早于女性;青年冠心病组吸烟及有冠心病家族史的比例高于中年冠心病组及老年冠心病组(P＜0.01)。⑩不稳定型心绞痛组的冠脉狭窄程度小于陈旧性心肌梗死组和急性心肌梗死组(P＜0.01)。陈旧性心肌梗死组的Gensini积分最高(P＜0.01)。稳定型心绞痛组最易有弥漫性病变(P＜0.05)。结论:①在左前降支、左回旋支和右冠状动脉3支血管中,左前降支最易受累。②高龄、男性、合并糖尿病、吸烟、超重的陈旧性心肌梗死患者冠脉狭窄程度一般较严重,多支冠脉病变多见。③高龄、超重及合并糖尿病的稳定型心绞痛患者易有弥漫性病变。④空腹血糖、总胆固醇、脂蛋白(a)和纤维蛋白原水平较高,而高密度脂蛋白胆固醇和载脂蛋白A水平较低的冠心病患者冠脉狭窄程度较重,多支冠脉病变及弥漫性血管病变多见。更多还原

【Abstract】 Objective:This study is to investigate the relationship between the risk factors of coronary artery disease and the coronary artery lesions.Methods:A total of 2513 consecutive patients who had been diagnosed as coronary heart disease (CHD)or without CHD by coronary angiography(2000～2007)were studied retrospectively. The relationship between the risk factors and clinic type of CHD and the characteristic of coronary artery lesions which expressed by severity of coronary artery,Gensini cumulative index,branch number of stenosis coronary artery,diffuse lesions and the lesions of left anterior descending of coronary artery(LAD),left circumflex coronary artery(LCX),right coronary artery(RCA)and left main of coronary artery(LM)was analyzed.Results:①Age,systolic blood pressure(SBP),fasting blood glucose(FBG),course of diabetes mellitus(DM),triglyceride(TG),low-density lipoprotein cholesterol(LDH),high-density lipoprotein cholesterol(HDL),apolipoproteins A(APOA),apolipoproteins B(APOB), lipoprotein(a)(LP(a)),total bilirubin(TBIL)and uric acid(UA)have relationships with CHD(P＜0.01).②There are positive correlations between the degree of coronary artery stenosis and male,regular smoking,overweight,age,FBG,TBIL and indirect bilirubin(IBIL) (P＜0.01 or P＜0.05).③There are correlations between male Gensini cumulative index and age,HDL,FBG,body mass index(BMI)and LP(a)(P＜0.01 or P＜0.05):male Gensini cumulative index=-43.419+0.999AGE-25.686HDL+3.137BFS+2.051BMI+0.464 LP(a). There are correlations between female Gensini cumulative index and FBG,total cholesterol (TC),fibrinogen(FIB)and LP(a)(P＜0.01 or P＜0.05):female Gensini cumulative index=-126.860+3.604BFS +7.639FIB+6.984 LP(a)+4.667TC.④DM,hypertension, overweight,age,FBG and FIB are positively correlated with branch number of stenosis coronary artery(P＜0.01 or P＜0.05).HDL and APOA are negatively correlated with branch number of stenosis coronary artery(P＜0.01).⑤DM,overweight,age,FBG,APOB,LP(a), DBIL and FIB are positively correlated with diffuse lesions(P＜0.01 or P＜0.05).HDL is negatively correlated with diffuse lesions(P＜0.01).⑥The incidence of graveness stenosis of LAD in male is higher than in female.DM,overweight and smoking have relationship with severe lesions of LAD(P＜0.01 or P＜0.05).⑦DM,overweight,HDL,FBG and APOA have relationship with lesions of LCX.FBG and overweight are positively correlated with lesions of LCX(P＜0.01).HDL and APOA are negatively correlated with lesions of LCX(P＜0.01).⑧Hypertension,DM,overweight and HDL have relationship with lesions of RCA.HDL is negatively correlated with lesions of RCA(P＜0.01).⑨Male develop CHD earlier than female.Compared with other groups,the rates of smoking and family history of CHD in young-CHD group were higher(P＜0.01).⑩The degree of coronary artery stenosis in unstable angina pectoris group is higher than in old myocardial infarction group and acute myocardial infarction group(P＜0.01).The Gensini cumulative index in old myocardial infarction group is highest(P＜0.01).People with stable angina pectoris are apt got diffuse lesions(P＜0.05).Conclusion:①LAD is apt of suffering from lesions than LCX and RCA.②Male patients with great age,DM,BMI≥25kg/m~2 and history of smoking and myocardial infarction are apt of suffering from severe and multivessel lesions.③Patients with great age,DM, BMI≥25kg/m~2 and stable angina pectoris are apt of suffering from diffuse lesions.④Patients with high BFS,TC,LP(a)and FIB and low HDL-C and APOA are apt of suffering from severe,multivessel and diffuse lesions.更多还原