冠心病家族史陽性PCI患者臨床和冠狀動脈病變特點分析
發(fā)布時間：2018-10-16 22:38
【摘要】：目的:分析經(jīng)皮冠狀動脈介入治療(PCI)伴冠心病家族史陽性患者臨床及冠狀動脈病變特點。方法:回顧性搜集2006年12月至2014年6月于泰達國際心血管病醫(yī)院行冠狀動脈造影明確診斷冠心病并行PCI患者共13,800例,電話隨訪篩選其中冠心病家族史陽性者(陽性組),按患病親屬類型分為父母患病組(父母組)、兄弟姐妹患病組(兄妹組)和父母兄弟姐妹均患病組(混合組);隨機抽取同期于我院行冠狀動脈造影明確診斷冠心病并行PCI患者中無冠心病家族史者1000例作為對照組。對比各組間臨床及冠狀動脈病變特點。結(jié)果:1.陽性組(1,300例,占PCI總數(shù)的9.4%)患者體重指數(shù)(BMI)、平均病變支數(shù),以及糖尿病、高血壓病、左主干病變和單/雙/三支病變發(fā)生率與陰性組一致;年齡和吸煙患者發(fā)生率顯著低于陰性組(60.3:61.9,P0.001;49.8%:55.3%,P=0.010);男性、高脂血癥、心肌梗死、右冠狀動脈/開口/慢性完全閉塞(CTO)病變發(fā)生率和平均植入支架數(shù)均顯著大于陰性組(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.父母組的平均年齡顯著低于陰性組(57.3:61.9,P=0.000),而男性、高脂血癥患者比例及平均病變支數(shù)、開口/CTO病變比例均高于陰性組(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)。兄妹組的平均BMI、吸煙患者比例及單支病變比例低于陰性組(25.9:26.2,P=0.018;30.0%:37.3%,P=0.005),而平均年齡、平均植入支架數(shù),高脂血癥、心肌梗死、三支病變及開口病變、CTO病變比例均高于陰性組(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)。混合組單支病變比例低于陰性組(29.0%:37.3%,P=0.031),而高血壓、高脂血癥患者比例及心肌梗死、三支病變、開口病變、CTO病變比例均高于陰性組(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.對比父母組(599例,占陽性者的46.1%),兄妹組(515例,39.6%)的年齡、平均病變支數(shù)和糖尿病、三支病變發(fā)生率明顯增高(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、吸煙、單支病變發(fā)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)�；旌辖M(186例,占陽性者的14.3%)的年齡、平均病變數(shù),以及高血壓病、高脂血癥和開口病變發(fā)生率高于父母組(p0.05),bmi以及高脂血癥、高血壓病發(fā)生率也高于兄妹組(p0.05)。4.三組人群gensini積分中等組均無顯著差異。父母組gensini積分低分組顯著高于兄妹組和陰性組(27.5%vs20.8%,p=0.009;27.5%vs18.0%,p=0.000),較高分組與兄妹組無顯著差異,但顯著低于陰性組(24.2%vs33.3%,p=0.000),高分組略多于陰性組但并無統(tǒng)計學(xué)差異,顯著低于兄妹組(21.7%vs30.5%,p=0.001)。兄妹組中低分組和中等組與對照組無顯著差異,較高分組顯著低于陰性組,高分組顯著高于陰性組(30.5%vs19.3%,p=0.000)。結(jié)論:1.pci患者中冠心病家族史陽性率為9.4%。通過無冠心病家族史pci患者和有冠心病家族史pci患者一般資料比較發(fā)現(xiàn),陽性冠心病家族史pci患者的平均發(fā)病年齡偏小,吸煙率低,而男性、高脂血癥、心肌梗死和右冠狀動脈病變、開口病變、cto病變發(fā)生率高,平均植入支架數(shù)更高。2.冠心病家族史陽性亞組同無冠心病家族史pci患者比較發(fā)現(xiàn),父母患病者的平均年齡低,而男性、高脂血癥患者比例高,平均病變支數(shù)、復(fù)雜病變(開口和cto)比例高;兄弟姐妹患者者的平均體重系數(shù)、吸煙率、單支病變比例低,平均年齡高,平均植入支架數(shù)、高脂血癥、心肌梗死、三支病變及復(fù)雜病變比例高;混合組單支病變比例低,而高血壓、高脂血癥、心肌梗死、三支病變、復(fù)雜病變比例高。3.陽性亞組間比較發(fā)現(xiàn),相比于父母患病者,兄弟姐妹患病者的平均發(fā)病年齡高,平均病變支數(shù)、糖尿病、右冠狀動脈、三支病變發(fā)生率高,gensini積分高分組比例更高。說明兄弟姐妹患者相比與父母患者有更高的危險性。4.總之,冠心病家族史患者,尤其父母患病者的平均年齡更低。陽性冠心病家族史患者其他危險因素比例更高,冠狀動脈嚴重程度更重,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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.4
本文編號：2275844
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.4
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