冠心病家族史阳性PCI患者临床和冠状动脉病变特点分析

发布时间：2018-10-16 22:38

【摘要】：目的:分析经皮冠状动脉介入治疗(PCI)伴冠心病家族史阳性患者临床及冠状动脉病变特点。方法:回顾性搜集2006年12月至2014年6月于泰达国际心血管病医院行冠状动脉造影明确诊断冠心病并行PCI患者共13,800例,电话随访筛选其中冠心病家族史阳性者(阳性组),按患病亲属类型分为父母患病组(父母组)、兄弟姐妹患病组(兄妹组)和父母兄弟姐妹均患病组(混合组);随机抽取同期于我院行冠状动脉造影明确诊断冠心病并行PCI患者中无冠心病家族史者1000例作为对照组。对比各组间临床及冠状动脉病变特点。结果:1.阳性组(1,300例,占PCI总数的9.4%)患者体重指数(BMI)、平均病变支数,以及糖尿病、高血压病、左主干病变和单/双/三支病变发生率与阴性组一致;年龄和吸烟患者发生率显著低于阴性组(60.3:61.9,P0.001;49.8%:55.3%,P=0.010);男性、高脂血症、心肌梗死、右冠状动脉/开口/慢性完全闭塞(CTO)病变发生率和平均植入支架数均显著大于阴性组(70.4%:62.0%,67.4%:44.8%,36.0%:29.1%,P均=0.000;61.6%:59.4%,P=0.007;21.0%:14.5%,P=0.000;12.0%:8.5%,P=0.006;1.93:1.74,P=0.000)。2.父母组的平均年龄显著低于阴性组(57.3:61.9,P=0.000),而男性、高脂血症患者比例及平均病变支数、开口/CTO病变比例均高于阴性组(75.3%:62.0%,P=0.000;70.0%:44.8%,P=0.000;1.90:1.98,P=0.045;19.9%:14.5%,P=0.005;11.7%:8.5%,P=0.037)。兄妹组的平均BMI、吸烟患者比例及单支病变比例低于阴性组(25.9:26.2,P=0.018;30.0%:37.3%,P=0.005),而平均年龄、平均植入支架数,高脂血症、心肌梗死、三支病变及开口病变、CTO病变比例均高于阴性组(63.2:61.9,P=0.006;1.98:1.74,P=0.000;63.3%:44.8%,P=0.000;38.4%:29.1%,P=0.000;36.2%:29.6%,P=0.008;19.8%:14.5%,P=0.011;12.2%:8.5%,P=0.020)。混合组单支病变比例低于阴性组(29.0%:37.3%,P=0.031),而高血压、高脂血症患者比例及心肌梗死、三支病变、开口病变、CTO病变比例均高于阴性组(66.0%:60.3%,P=0.011;82.4%:44.8%,P=0.000;36.2%:29.1%,P=0.046;37.1%:29.6%,P=0.047;28.0%:14.5%,P=0.000;12.7%:8.5%,P=0.011)。3.对比父母组(599例,占阳性者的46.1%),兄妹组(515例,39.6%)的年龄、平均病变支数和糖尿病、三支病变发生率明显增高(63.2:57.3,p=0.000;2.06:1.90,p=0.001;30.3%:23.8%,p=0.015;36.2%:28.4%,p=0.005),而男性、吸烟、单支病变发生率和bmi低(66.1%:75.3%,p=0.001;45.2%:53.7%,p=0.003;30.0%:39.1%,p=0.002;25.9:26.4,p=0.002)。混合组(186例,占阳性者的14.3%)的年龄、平均病变数,以及高血压病、高脂血症和开口病变发生率高于父母组(p0.05),bmi以及高脂血症、高血压病发生率也高于兄妹组(p0.05)。4.三组人群gensini积分中等组均无显著差异。父母组gensini积分低分组显著高于兄妹组和阴性组(27.5%vs20.8%,p=0.009;27.5%vs18.0%,p=0.000),较高分组与兄妹组无显著差异,但显著低于阴性组(24.2%vs33.3%,p=0.000),高分组略多于阴性组但并无统计学差异,显著低于兄妹组(21.7%vs30.5%,p=0.001)。兄妹组中低分组和中等组与对照组无显著差异,较高分组显著低于阴性组,高分组显著高于阴性组(30.5%vs19.3%,p=0.000)。结论:1.pci患者中冠心病家族史阳性率为9.4%。通过无冠心病家族史pci患者和有冠心病家族史pci患者一般资料比较发现,阳性冠心病家族史pci患者的平均发病年龄偏小,吸烟率低,而男性、高脂血症、心肌梗死和右冠状动脉病变、开口病变、cto病变发生率高,平均植入支架数更高。2.冠心病家族史阳性亚组同无冠心病家族史pci患者比较发现,父母患病者的平均年龄低,而男性、高脂血症患者比例高,平均病变支数、复杂病变(开口和cto)比例高;兄弟姐妹患者者的平均体重系数、吸烟率、单支病变比例低,平均年龄高,平均植入支架数、高脂血症、心肌梗死、三支病变及复杂病变比例高;混合组单支病变比例低,而高血压、高脂血症、心肌梗死、三支病变、复杂病变比例高。3.阳性亚组间比较发现,相比于父母患病者,兄弟姐妹患病者的平均发病年龄高,平均病变支数、糖尿病、右冠状动脉、三支病变发生率高,gensini积分高分组比例更高。说明兄弟姐妹患者相比与父母患者有更高的危险性。4.总之,冠心病家族史患者,尤其父母患病者的平均年龄更低。阳性冠心病家族史患者其他危险因素比例更高,冠状动脉严重程度更重,尤其是有兄弟姐妹患者者。
[Abstract]:Objective: To analyze the clinical and coronary artery disease characteristics of percutaneous coronary intervention (PCI) with family history of coronary heart disease (CHD). Methods: From December 2006 to June 2014, a total of 13,800 patients with coronary heart disease (PCI) were diagnosed by coronary angiography in Taida International Cardiovascular Hospital, and the positive group of family history of coronary heart disease (positive group) was screened by telephone follow-up. The relatives were divided into two groups (parent group), brother and sister group (brother and sister group), and parent and sister group (mixed group). A group of 1000 patients with coronary heart disease (CHD) who had no history of coronary heart disease were randomly selected as control group. To compare the characteristics of clinical and coronary lesions among the groups. Result: 1. The incidence of body mass index (BMI), mean lesion revascularization, and diabetes, hypertension, left trunk lesion, and single/ double/ triple lesions were consistent with the negative group in the positive group (1, 300, 9. 4% of the total number of PCI); the incidence of age and smoking was significantly lower than in the negative group (60. 3: 69.1, P0. 001; 49. 8%: 55. 3%, P = 0. 010); the incidence and average number of implanted stents in men, hyperlipidemia, myocardial infarction, right coronary/ open/ chronic total occlusion (CTO) were significantly greater than that of the negative group (70.4%: 62. 0%, 67. 4%: 44. 8%, 36. 0%: 29. 1%, P = 0. 000; 61.6%: 59.4%,P=0.007;21.0%:14.5%,P=0.000;12.0%:8.5%,P=0.006;1.93:1.74,P=0.000).2. The mean age of parent group was significantly lower than that of negative group (57. 3: 60.9, P = 0.000), while the proportion of male and hyperlipidemic patients was higher than that of the negative group (75.3%: 62. 0%, P = 0. 000; 70. 0%: 44. 8%, P = 0. 000; 1. 90: 1. 98, P = 0. 000; 19. 9%: 14.5%, P = 0.0005; 11.7%:8.5%,P=0.037). The mean BMI of siblings, the proportion of smoking patients and the proportion of single lesions were lower than those in the negative group (25.9: 2.6. 2, P = 0.018; 30. 0%: 37. 3%, P = 0. 005), while the mean age, mean number of implanted stents, hyperlipidemia, myocardial infarction, triple lesions and open lesions, CTO lesions were all higher than those of the negative group (63.2: 61.9,P=0.006;1.98:1.74,P=0.000;63.3%:44.8%,P=0.000;38.4%:29.1%,P=0.000;36.2%:29.6%,P=0.008;19.8%:14.5%,P=0.011;12.2%:8.5%,P=0.020). The proportion of single branch lesion in the mixed group was lower than that of the negative group (29. 0%: 37. 3%, P = 0.031), while the proportion of hypertension and hyperlipidemia was higher than that of the negative group (66. 0%: 60. 3%, P = 0.011; 82.4%: 44. 8%, P = 0.000; 36. 2%: 29. 1%, P = 0.046; 37.1%:29.6%,P=0.047;28.0%:14.5%,P=0.000;12.7%:8.5%,P=0.011).3. Compared with parent group (599 cases, 46.1% of positive cases), sister and sister group (515 cases, 39. 6%), the incidence of three lesions was significantly higher (63.2: 57. 3, p = 0.000; 2.06: 1.90, p = 0.00001; 30.3%: 23.8%, p = 0.015; 36. 2%: 28. 4%, p = 0. 005), while men, Smoking, single lesion and bmi were low (66. 1%: 75. 3%, p = 0. 001; 4.5. 2%: 53. 7%, p = 0. 003; 30. 0%: 39. 1%, p = 0. 002; 25. 9: 26. 4, p = 0. 002). The incidence of hypertension, hyperlipidemia and open lesions was higher in the mixed group (186 cases, 14. 3% of the positive cases), and the incidence of hypertension, hyperlipidemia and open lesions was higher than that of the parent group (P0.05). There was no significant difference between the three groups of population gensini integral moderate group. There was no significant difference between the group of parents and the group of siblings (27. 5% vs. 20.8%, p = 0.0009; 27. 5% vs. 18. 0%, p = 0. 000), but was significantly lower than that of the negative group (2.4% vs. 33.3%, p = 0. 000), whereas the higher group was slightly more than the negative group but there was no statistical difference, significantly lower than that of the siblings (21. 7% vs. 30. 5%, p=0.001). There was no significant difference between the lower group and the middle group in the brother and sister group compared with the control group, the higher group was significantly lower than that of the negative group, and the high group was significantly higher than that of the negative group (34.5% vs. 19.3%, p = 0.000). Conclusion: The positive rate of family history of coronary heart disease in 1. pci patients is 94.4%. By comparing the general data of PCi patients with family history of coronary heart disease and PCi patients with family history of coronary heart disease, the average onset age of PCi patients with positive coronary heart disease is small, smoking rate is low, while men, hyperlipidemia, myocardial infarction and right coronary artery disease, open lesions, The incidence of cto lesions was high and the average number of implanted stents was higher. Compared with PCi patients without family history of coronary heart disease, the positive sub-group of family history of coronary heart disease found that the average age of parents affected the disease was low, while the proportion of male and hyperlipidemic patients was high, the ratio of complicated lesion (opening and cto) was high, and the average body weight coefficient of patients with siblings was higher. Smoking rate, single lesion ratio was low, mean age was high, average implanted stent number, hyperlipidemia, myocardial infarction, triple lesion and complex lesion ratio were high; the proportion of single branch lesion in mixed group was low, while hypertension, hyperlipidemia, myocardial infarction, triple lesion and complex lesion ratio were high. The positive sub-group found that the average incidence of disease was higher than that of parents affected by the disease, the average lesion revascularization, diabetes mellitus, right coronary artery, triple lesion rate was high, and the genenini integral high packet ratio was higher. Explain that sibling patients have a higher risk compared to their parents. In short, patients with family history of coronary heart disease, especially parents, have a lower average age. The proportion of other risk factors in patients with family history of positive coronary heart disease is higher, and the severity of coronary artery is more serious, especially those with siblings.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4

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