冠心病患者家族性高胆固醇血症的检出率及临床特点分析

Detection rate and clinical characteristics of familial hypercholesterolemia in patients with coronary heart disease

关键词:  冠心病  家族性高胆固醇血症  检出率  临床特点

Key words:  CHD  family hypercholesterol  prevalence  clinical characteristics

摘要:

目的　分析家族性高胆固醇血症（FH）在冠心病（CHD）患者中的检出率及临床特点。方法　选取2013年1月至2017年12月邯郸市中心医院心内科住院并首次经冠状动脉造影证实为冠心病的828例患者作为研究对象。根据冠心病的发病年龄将研究对象分为早发冠心病组（男性≤55岁，女性≤60岁）和非早发冠心病组。采集所有研究对象的临床资料，根据文献中的FH诊断标准，分析FH在冠心病患者中的检出率，与冠心病及他汀类药物治疗的关系，以及早发冠心病的危险因素。结果[HTK] （1）FH在早发冠心病患者中的检出率为8.31%，高于非早发冠心病患者的1.67%（P<0.05）。（2）不论是在总体冠心病患者中，还是早发冠心病组或者非早发冠心病组中，男女间的FH检出率差异均无统计学意义（P均>0.05）。（3）FH患者中发生早发冠心病比例为78.38%，远高于非FH患者的40.15%（P<0.05）。（4）与非FH组比较，FH组有较低的冠心病发病年龄，平均低11岁。（5）按血管病变部位分析，FH患者的左主干、左前降支、左回旋支和右冠状动脉的发生率均高于非FH患者；按血管病变数目分析，FH患者以双支病变为主（占67.57%），而非FH患者以单支病变为主（87.23%）（P均<0.05）。（6）多因素logistics回归分析，结果显示BMI、高血压、使用他汀类药物治疗、冠心病家族史、吸烟史、高脂血症、FH均是早发冠心病的危险因素，而FH患者发生早发冠心病的风险是非FH患者的6.77倍，其95%可信区间为3.28-12.61，具有统计学意义（P<0.05）。结论　FH是早发冠心病的重要危险因素，而且早发冠心病并发FH的患者多好发左冠状动脉狭窄且以双支病变为主。

Abstract:

Objective　To analyze the prevalence and clinical characteristics of familial hypercholesterolemia (FH) in patients with coronary heart disease (CHD). 　Methods　Totally 828 patients, who were admitted to the Department of Cardiology from January 2013 to December 2017 and diagnosed with CHD by coronary angiography, were selected as the subjects. According to age, the subjects were divided into premature CHD (≤55 years for men, ≤60 years for women) and non-premature CHD. The clinical data of all subjects were collected. According to the FH diagnostic criteria in the literature, the prevalence of FH in patients with CHD was analyzed. The relationship between CHD and statins was analyzed, and the risk factors for premature CHD were comprehensively analyzed. 　Results　(1) The prevalence of FH in patients with premature CHD was 8.31%, which was higher than 1.67% of non-premature CHD (P<0.05). (2) There was no statistical difference in the prevalence of FH between men and women in all CHD patients, the premature CHD group, or the non-premature CHD group (P>0.05). (3) The rate of premature CHD in FH patients was 78.38%, which was much higher than 40.15% of non-FH patients (P<0.05). (4) Compared with the non-FH group, the FH group had a lower age of CHD onset with 11 years younger in average. (5) According to the location of vascular lesions, the incidence of left trunk, left anterior descending branch, left spiral branch and right coronary artery lesions in FH patients was higher than that of non-FH patients. According to the number of vascular lesions, FH patients mainly had double-branch lesions (67.57%), while non-FH patients were mainly single-branch lesions (87.23%) (P<0.05). (6) Multiple factor logistic regression analysis showed that BMI, hypertension, statins, family history of CHD, smoking history, hyperlipidemia, and FH were risk factors for early CHD. The risk of early CHD in FH patients was 6.77 times higher than non-FH patients (95% confidence interval 3.28-12.61, P<0.05). 　Conclusion　FH is an important risk factor for premature CHD, and FH patients complicated with premature CHD tend to have left coronary artery stenosis and double vessel lesions.