不同种族冠心病患者心血管危险因素的对比研究

沈潇; 张晓峰; 汤涌

摘要: 目的：目前有研究显示种族之间的差异可能影响冠心病的传统危险因素与该病的发病机制及严重程度之间的关系。但是将两个种族通过冠脉造影方式诊断冠心病并且将其危险因素进行对比的研究少之甚少。世界上有许多心血管疾病指南，虽然这些临床指南可以帮助治疗，但是种族之间的差异提示个体化治疗。故我们研究不同种族之间（中国与德国）不同年龄组冠心病心血管危险因素的分布情况并进行对比，希望对于个体化治疗提供帮助。方法：2016年2月至2017年7月期间收集中国东南大学附属第二医院新诊断为冠心病患者病例（共350例）与德国乌尔姆大学附属医院新诊断为冠心病患者病例（共300例），包括患者血糖、血脂、肌酐水平以及吸烟等不良生活方式。将650例患者分为＜45岁（44例），45-59岁（112例），60-74岁（219例），≥75岁（275例）4个组进行比较。此外，进行logistic回归分析，分析不同种族之间冠心病危险因素与冠状动脉病变严重程度之间的关联性。结果：＜45岁年龄组中德冠心病患者在性别比例（P=0.019）和体重指数BMI（P=0.009）上有显著性差异；45-59岁年龄组中德冠心病患者在性别（P=0.002）、BMI（P=0.002）、CRP（P=0.001）、TC（P=0.002）、HDL-C（P=0.000）以及吸烟（P=0.02）上有显著性差异；60-74岁年龄组中德冠心病患者在BMI（P=0.000）、糖尿病史（P=0.007）空腹血糖（P=0.000）、CRP（P=0.011）、TC（P=0.000）、TG（P=0.025）HDL-C（P=0.000）以及吸烟（P=0.002）上有显著性差异；≥75岁年龄组中德冠心病患者在BMI（P=0.001）、空腹血糖（P=0.000）、CRP（P=0.001）、TC（P=0.000）、 TG（P=0.000）、HDL-C（P=0.000）、LDL-C（P=0.001）以及吸烟（P=0.016）、冠状动脉严重程度（P=0.000）上有显著性差异。中国组冠脉严重程度与年龄（P=0.012）、性别（P=0.003）、高血压（P=0.001）及糖尿病（P=0.006）相关，德国组冠脉严重程度与高血压（P=0.031）、糖尿病（P=0.001）及肌酐（P=0.039）相关。结论：不同种族之间（中国与德国）不同年龄组冠心病心血管危险因素的分布情况不同。

Abstract: Background: Ethnic difference may affect associations between conventional risk factors for coronary artery disease (CAD) and the pathogenesis and severity of this disease. However, there is a lack of direct comparison based on angiographically approved CAD cohorts. In addition, there are many guidelines for cardiovascular diseases in the world. Although it is hoped that these clinical guidelines can assist in the treatment, differences between races prompts for individualized treatment. Therefore, we studied the distribution of cardiovascular risk factors of coronary heart disease among different races (China and Germany) in different age groups, and compared them, hoping to provide help for individualized treatment.Methods: Overall, 650 patients were included. Among these patients, 300 patients were from Germany and 350 patients were from China. In this cross-sectional study of two study centers in China and Germany, the prevalence of conventional risk factors in angiographically evidenced CAD patients stratified by age from February 1, 2016 to July 31, 2017 were compared. Furthermore, a logistic regression analysis was performed to identify associations between the prevalence of these factors and the severity of coronary lesions. Results: Less than 45 year old age group of Chinese and German patients with coronary heart disease had significant differences in gender (P=0.019) and body mass index BMI (P=0.009); the 45-59 age group had significant differences in gender (P=0.002), BMI (P=0.002)，CRP (P=0.001), TC (P=0.002), HDL-C (P=0.000) and smoking (P=0.02); the 60-74 age group had significant differences in BMI (P=0.000) ，diabetes mellitus (P=0.007) ，fasting blood glucose (P=0.000), CRP (P=0.011), TC (P=0.000), TG (P=0.025) ，HDL-C (P=0.000) and smoking (P= 0.002); more than 75 year old age group had significant differences in BMI (P=0.001), fasting blood glucose (P=0.000), CRP (P=0.001), TC (P=0.000), TG (P=0.000), HDL-C (P=0.000), LDL-C (P=0.001) and smoking (P=0.016) . Besides, there was a significant difference in the severity of coronary artery (P=0.000) in more than 75 year old age group . The severity of coronary artery in Chinese group was related to age (P=0.012), gender (P=0.003), hypertension (P=0.001) and diabetes mellitus (P=0.006). The severity of coronary artery in German group was related to hypertension (P=0.031), diabetes mellitus (P=0.001) and creatinine (P=0.039). That is to say, c omorbidities of hypertension and DM were independent predictors to the severity of coronary lesions in both cohorts, while the level of serum Cr remained as an independent predictor of severer coronary lesions in patients from Germany.Conclusion: Differences may exist on the strength of the association between conventional CAD risk factors and the pathogenesis of CAD and its severity in these two cohorts of CAG-evidenced CAD patients from China and Germany

不同种族冠心病患者心血管危险因素的对比研究

Differences of prevalent risk factors for patients of coronary artery disease among different races