CAJ | 학술논문

目的：探讨早发冠心病患者的危险因素及血运重建情况。方法选择356例行冠脉造影术确诊为冠心病的患者，按年龄分为早发冠心病组（PCHD 组，男性≤55岁，女性≤65岁，70例）和晚发冠心病组（LCHD 组，男性﹥55岁，女性﹥65岁，286例）。对两组患者的性别、体重指数、PCHD 家族史、高血压病史、糖尿病史、吸烟史、饮酒史，血脂、糖化血红蛋白、尿酸、高敏 C 反应蛋白水平以及冠脉血运重建情况进行比较分析。结果①患者一般情况 PCHD 组的男性发病率、吸烟率、饮酒率、体重指数均高于 LCHD 组；PCHD 组的年龄、PCHD 家族史阳性率、高血压、糖尿病患病率均明显低于 LCHD组，且高血压病程也明显短于 LCHD 组（ P ﹤0.05）。②PCHD 组的总胆固醇、低密度脂蛋白胆固醇、甘油三酯水平均明显高于 LCHD 组（ P ﹤0.01），而高密度脂蛋白胆固醇水平低于 LCHD 组（ P ＝0.013）；PCHD 组血尿酸、高敏 C 反应蛋白水平均低于 LCHD 组（ P ﹤0.05）。③早发冠心病的多因素 Logistic 回归分析显示吸烟史（OR 7.793，P ﹤0.001）和高 LDL - C水平（OR 3.745，P ﹤0.001）与早发冠心病明显相关，为其独立危险因素。④PCHD 组介入治疗率高于 LCHD 组，但差异未达到统计学意义（ P ＝0.340）；PCHD 组患者未选择血运重建的比率低于 LCHD 组，差异有统计学意义（ P ＝0.044）；PCHD组需行冠状动脉旁路移植术（CABG）比率低于 LCHD 组，差异有显著统计学意义（ P ﹤0.001）。结论吸烟、高胆固醇血症是早发冠心病患者的独立危险因素，早期干预有助于降低早发冠心病的患病率。早发冠心病患者选择 CABG 术和非血运重建的比率均低于晚发者，选择合理的介入治疗和优化的药物治疗可能有助于改善 PCHD 患者预后。
목적：탐토조발관심병환자적위험인소급혈운중건정황。방법선택356례행관맥조영술학진위관심병적환자，안년령분위조발관심병조（PCHD 조，남성≤55세，녀성≤65세，70례）화만발관심병조（LCHD 조，남성﹥55세，녀성﹥65세，286례）。대량조환자적성별、체중지수、PCHD 가족사、고혈압병사、당뇨병사、흡연사、음주사，혈지、당화혈홍단백、뇨산、고민 C 반응단백수평이급관맥혈운중건정황진행비교분석。결과①환자일반정황 PCHD 조적남성발병솔、흡연솔、음주솔、체중지수균고우 LCHD 조；PCHD 조적년령、PCHD 가족사양성솔、고혈압、당뇨병환병솔균명현저우 LCHD조，차고혈압병정야명현단우 LCHD 조（ P ﹤0.05）。②PCHD 조적총담고순、저밀도지단백담고순、감유삼지수평균명현고우 LCHD 조（ P ﹤0.01），이고밀도지단백담고순수평저우 LCHD 조（ P ＝0.013）；PCHD 조혈뇨산、고민 C 반응단백수평균저우 LCHD 조（ P ﹤0.05）。③조발관심병적다인소 Logistic 회귀분석현시흡연사（OR 7.793，P ﹤0.001）화고 LDL - C수평（OR 3.745，P ﹤0.001）여조발관심병명현상관，위기독립위험인소。④PCHD 조개입치료솔고우 LCHD 조，단차이미체도통계학의의（ P ＝0.340）；PCHD 조환자미선택혈운중건적비솔저우 LCHD 조，차이유통계학의의（ P ＝0.044）；PCHD조수행관상동맥방로이식술（CABG）비솔저우 LCHD 조，차이유현저통계학의의（ P ﹤0.001）。결론흡연、고담고순혈증시조발관심병환자적독립위험인소，조기간예유조우강저조발관심병적환병솔。조발관심병환자선택 CABG 술화비혈운중건적비솔균저우만발자，선택합리적개입치료화우화적약물치료가능유조우개선 PCHD 환자예후。
Objective To analyze the risk factors and revascularization in patients with premature coronary heart disease( PCHD). Methods 356 coronary heart disease patients(underwent coronary angiography and confirmed)were selected into this study. 70 patients with PCHD and 286 patients with late CHD(LCHD)were divided according to age. The risk factors including sex,body mass index(BMI),history of hypertension,diabetes,smoking,alcohol consumption,premature family history of cardiovascular disease,and the level of glycosylated hemo-globins(HbA1c),blood lipid,high sensitivity C reactive protein(hs - CRP),serum uric acid,and different coronary revascularizations between PCHD group and LCHD group were analyzed. Results ①Patients with PCHD had higher level of BMI and rate of male incidence,smoking and alcohol drinking compared with the LCHD group,but the rate of premature family history of CHD,hypertension and diabetes were lower than oth-ers. ②Patients with PCHD had higher level of total cholesterol(TC),triglyceride(TG),low - density lipoprotein cholesterol(LDL - C). The level of high - density lipoprotein cholesterol(HDL - C),hs - CRP and serum uric acid is lower than that of others. ③ Among the risk factors by multivariate Logistic regression analysis of PCHD,smoking(OR 7. 793,P ﹤ 0. 001)and higher level of LDL - c(OR 3. 745,P ﹤ 0. 001)were significant . ④Patients with PCHD had higher rate of percutaneous coronary intervention(PCI)than Patients with LCHD,but the difference was not significant . Patients with PCHD had lower rate of requiring coronary artery bypass grafting(CABG)compared with the LCHD group. Conclu-sion Smoking and hyperlipemia are major risk factors for PCHD. Therefore,early prevention can help to reduce the incidence of PCHD. The pa-tients with PCHD had lower rate of requiring CABG and non - revascularization. Given a reasonable PCI and the optimized drugs to the patients with PCHD could help to improve their prognosis .