早發冠心病臨床危險因素分析及其與預后的相關性探討

管錚

[摘要] 目的 研究早發冠心病患者的臨床危險因素以及與預后的關系，為臨床診治及預后提供科學依據。 方法 我院選擇2012年9月～2014年9月診治的1240例早發冠心病患者，依據其年齡及性別分為早發組和對照組，比較兩組患者之間的臨床指標、一般資料的差異，研究早發冠心病患者的相關危險因素。對所選患者進行24個月的隨訪觀察，運用Cox回歸模型分析對兩組患者的預后危險因素進行分析。 結果 通過對兩組患者的差異進行比較，早發冠心病發病的主要危險因素為冠心病家族史、吸煙史、高總膽固醇、高血壓、纖維蛋白原、甘油三酯以及血紅蛋白水平等。早發組患者的甘油三酯、總膽固醇、血紅蛋白水平以及纖維蛋白原水平明顯比對照組高，差異有統計學意義（P<0.05）。通過Cox多因素回歸分析可以得出，冠心病家族史、吸煙史、血紅蛋白、總膽固醇以及高血壓是對早發冠心病預后產生影響的五個因素，而飲酒史、吸煙史、高血壓以及總膽固醇四個因素是對晚期冠心病產生影響的預后因素。 結論 通過對存在危險因素的患者實施有針對性的干預措施，能夠有效降低早發冠心病患者出現幾率，合理進行飲食指導及提升控煙宣傳，多關注有陽性冠心病家族史人群，有效降低早發冠心病發病率及死亡率。

[關鍵詞] 早發冠心病；臨床危險因素；預后相關性

[中圖分類號] R541.4 [文獻標識碼] B [文章編號] 1673-9701（2017）13-0041-03

[Abstract] Objective To study the clinical risk factors of patients with early-onset coronary heart disease（CHD） and corresponding prognostic relationship， and to provide scientific basis for clinical diagnosis， treatment and prognosis. Methods 1240 patients with early-onset coronary heart disease who were diagnosed and treated in our hospital from September 2012 to September 2014 were divided into early-onset group and control group according to their age and sex. The differences in clinical indexes and general information between the two groups were compared. The risk-related factors of patients with early-onset coronary heart disease were studied. The patients were followed up for 24 months and the prognostic risk factors in two groups were analyzed by Cox regression model analysis. Results The differences between the two groups were compared.The main risk factors for early onset coronary heart disease were coronary heart disease family history， smoking history， high total cholesterol， hypertension， fibrin， triglyceride and hemoglobin levels.The levels of triglyceride， total cholesterol， hemoglobin and fibrinogen in the early-onset group were significantly higher than those in the control group（P<0.05）. Cox multivariate regression analysis showed that family history of coronary heart disease， smoking history， hemoglobin， total cholesterol and hypertension were the five factors that had an effect on the prognosis of early-onset coronary heart disease， while drinking history， smoking history， hypertension， and total cholesterol were prognostic factors for advanced coronary heart disease. Conclusion The targeted intervention measure applied in patients with risk factors can effectively reduce the risk of early-onset coronary heart disease patients，rationally guide diet and promote tobacco control propaganda， and more attention on the family history of positive coronary heart disease and effectively reduce the morbidity and mortality of coronary heart disease patients.

[Key words] Early onset coronary heart disease； Clinical risk factors； Prognostic relevance

冠心病簡稱為CHD，臨床是指因患者脂質代謝異常，在患者光滑的動脈內膜上堆積，隨著堆積時間的逐漸延長，體積逐漸變大，從而在患者體內出現白色的斑塊，臨床上也將其稱為動脈硬化，隨著斑塊的大量堆積和形成，導致患者的動脈管腔變窄，引起血流不暢，進而引起心絞痛，對患者的生活質量造成嚴重影響[1]。隨著我國經濟的高速發展，人們的生活水平明顯的提升，同時生活習慣和飲食結構也逐漸出現改變，人體內攝入的脂肪越來越多，血液越來越粘稠，進而導致早發冠心病發病危險因素的發生。……