2017 年第 8 期 第 12 卷

绝经前冠状动脉粥样硬化性心脏病患者冠状动脉病变特点及发病危险因素

Characteristics and risk factors of coronary artery lesion in premenopausal patients with coronary atherosclerotic heart disease

作者：武文峰陈盼盼聂绍平王绿娅

英文作者：Wu Wenfeng Chen Panpan Nie Shaoping Wang Luya

单位：100029首都医科大学附属北京安贞医院急诊危重症中心（武文峰、聂绍平）；100029北京市心肺血管疾病研究所动脉粥样硬化研究室(陈盼盼、王绿娅)

英文单位：Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China（Wu WF Nie SP）; Atherosclerosis Laboratory Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China（Chen PP Wang LY）

关键词：冠状动脉粥样硬化性心脏病；危险因素；冠状动脉病变；绝经前

英文关键词：Coronaryatheroscleroticheartdisease;Riskfactors;Coronaryarterylesions;Premenopause

• 摘要：

• 目的   分析绝经前冠状动脉粥样硬化性心脏病（冠心病）患者冠状动脉病变特点及发病危险因素。方法  回顾性分析2015年1月至2016年11月在首都医科大学附属北京安贞医院行冠状动脉造影的女性冠心病患者243例。根据是否已经绝经，将患者分为绝经前组（116例）和绝经后组（127例）。选择同期于首都医科大学附属北京安贞医院治疗的非冠心病女性患者112例为对照组。分析绝经前冠心病患者的冠状动脉病变特点，采用Logistic回归方法分析绝经前冠心病患者的发病危险因素。结果  绝经前组单支血管病变和完全闭塞病变比例高于绝经后组［60.3%(70/116)比45.7%（58/127）；54.3%（63/116）比15.7%（20/127）］，钙化病变比例低于绝经后组［1.7%(2/116)比11.8%（15/127）］，差异均有统计学意义(均P＜0.05)。绝经前组和绝经后组均以前降支病变为主［69.8%(81/116)，70.9%（90/127）］，其次是右冠状动脉和回旋支病变［38.8%（45/116）、34.5%（40/116），51.2%（65/127）、46.5%（59/127）］。Logistic回归分析结果显示，绝经前冠心病的发生与2型糖尿病、早发冠心病家族史和吸烟史存在相关性（比值比=4.722,95%置信区间:2.903～8.612, P=0.021；比值比=10.036, 95%置信区间: 5.372～25.634, P=0.004；比值比=3.627, 95%置信区间: 2.416～6.879, P=0.017）。结论  绝经前冠心病患者冠状动脉病变以单支病变为主，主要累及前降支。2型糖尿病、早发冠心病家族史和吸烟史是绝经前冠心病患者发病的独立危险因素。

• Objective  To analyze features and risk factors of coronary artery lesion in premenopausal patients with coronary heart disease（CHD）. Methods  Two hundreds and forty-three female patients with CHD from January 2015 to November 2016 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; they were divided into premenopausal group（116 cases） and postmenopausal group（127 cases）. One hundred and twelve female patients without CHD were selected as control group. Characteristics of coronary artery lesions of premenopausal CHD were analyzed. Risk factors of CHD in premenopausal women were analyzed. Results  Single vessel lesion rate and total occlusion lesion rate in premenopausal group were significantly higher and calcified lesion rate was significantly lower than those in postmenopausal group［60.3% （70/116） vs 45.7% （58/127）, 54.3% （63/116） vs 15.7% （20/127）, 1.7% （2/116） vs 11.8% （15/127）］（P＜0.05）. Anterior descending branch lesion rates in premenopausal group and postmenopausal group were 69.8% （81/116） vs 70.9% （90/127）; right coronary artery and circumflex branch lesion rates were 38.8%（45/116） vs 51.2%（65/127）, 34.5%（40/116） vs 46.5%（59/127）, respectively. Logistic regression analysis showed that the occurrence of CHD in premenopausal women was associated with type 2 diabetes, family history of premature CHD and smoking history（odds ratio=4.722, 95% confidence interval: 2.903-8.612, P=0.021; odds ratio=10.036, 95% confidence interval: 5.372-25.634, P=0.004; odds ratio=3.627, 95% confidence interval: 2.416-6.879, P=0.017）. Conclusions  Premenopausal CHD mainly manifests single vessel lesion; most lesions involve anterior descending branch. Type 2 diabetes, family history of premature CHD and smoking history are independent risk factors of premenopausal CHD.