[1]沈佳佳,牛锁成,刘淼,等.围绝经期女性冠状动脉粥样硬化性心脏病危险因素分析[J].新乡医学院学报,2023,40(2):159-164.[doi:10.7683/xxyxyxb.2023.02.012]
　SHEN Jiajia,NIU Suocheng,LIU Miao,et al.Risk factors for coronary atherosclerotic heart disease in perimenopausal women[J].Journal of Xinxiang Medical University,2023,40(2):159-164.[doi:10.7683/xxyxyxb.2023.02.012]
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围绝经期女性冠状动脉粥样硬化性心脏病危险因素分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年2期
页码:
159-164
栏目:
临床研究
出版日期:
2023-02-05

文章信息/Info

Title:
Risk factors for coronary atherosclerotic heart disease in perimenopausal women
作者:
沈佳佳; 牛锁成; 刘淼; 王凡; 朱凤娟
（新乡医学院附属濮阳市人民医院心内二科，河南　濮阳　457005）
Author(s):
SHEN Jiajia; NIU Suocheng; LIU Miao; WANG Fan; ZHU Fengjuan
(The Second Department of Cardiology,Puyang People′s Hospital Affiliated to Xinxiang Medical University,Puyang 457005,Henan Province,China)
关键词:
围绝经期; 冠状动脉粥样硬化性心脏病; 危险因素
Keywords:
perimenopause; coronary atherosclerotic heart disease; risk factors
分类号:
R541.4
DOI:
10.7683/xxyxyxb.2023.02.012
文献标志码:
A
摘要:
目的　探讨围绝经期女性发生冠状动脉粥样硬化性心脏病（CHD）的危险因素。
方法　选择2019年10月至2021年12月因“胸痛、胸闷”等就诊于濮阳市人民医院的围绝经期女性170例为研究对象，所有受试者行冠状动脉CT血管成像或造影检查，依据检查结果将受试者分为CHD组（n=85）和非CHD组（n=85），比较2组受试者的一般资料、入院时丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、血糖、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、动脉硬化指数、尿素氮（BUN）、尿酸(UA)、肌酐（Cr）、白细胞（WBC）计数、红细胞（RBC）计数、血红蛋白（Hb）、红细胞压积（HCT）、红细胞平均体积（MCV）、红细胞分布宽度标准差（RDW-SD）、红细胞分布宽度变异系数（RDW-CV）、 血小板（PLT）计数、血小板分布宽度（PDW）、平均血小板体积（MPV）、血小板压积（PCT）、左心室舒张末期内径（LVDd）、射血分数（EF%），分析其与患者CHD发病的相关性，logistic多因素回归分析围绝经期女性发生CHD的独立危险因素，受试者操作特征（ROC)曲线评估危险因素对CHD的诊断价值。
结果　年龄、体质量、高血压病史、高脂血症史、TC、LDL-C、动脉硬化指数、BUN、UA、Cr、RBC计数、Hb、HCT、MCV、RDW-SD、RDW-CV、PLT计数、PDW、MPV、PCT、LV与围绝经期女性发生CHD无关（P>0.05）；糖尿病史、血糖、ALT、AST、TG、WBC计数、HDL-C、EF水平与围绝经期女性发生CHD有关（P<0.05）。Logistic多因素回归分析显示，HDL-C是围绝经期女性发生CHD的独立保护因素（OR=0.237，P<0.05）。ALT预测围绝经期女性发生CHD的曲线下面积（AUC）为0.673，95％置信区间（CI）为0.592~0.553，灵敏度为44.7％，特异度为81.2％，最佳切点为20.75 U·L-1（P<0.01）；AST预测围绝经期女性发生CHD的AUC为 0.616，95％CI为0.531~0.701，灵敏度为49.4％，特异度为76.5％，最佳切点为20.75 U·L-1（P<0.05）；血糖预测围绝经期女性发生CHD的AUC为0.550，95％CI为0.463~0.637（P>0.05）；TG预测围绝经期女性发生CHD的AUC为0.602，95％CI为0.517~0.687，灵敏度为51.8％，特异度为69.4％，最佳切点为 1.765 mmol·L-1（P<0.05）；HDL-C预测围绝经期女性发生CHD的AUC为0.642，95％CI为0.559~0.725，灵敏度为20.0％，特异度为61.2％，最佳切点为1.325 mmol·L-1（P<0.01）；WBC计数预测围绝经期女性发生CHD的AUC为0.620，95％CI为 0.536~0.704，灵敏度为72.9％，特异度为50.9％，最佳切点为5.325×109 L-1（P<0.05）；EF预测围绝经期女性发生CHD的AUC为0.609，95％CI为0.525~0.694，灵敏度为61.2％，特异度为 17.6％，最佳切点为61.5%（P<0.05）。
结论　糖尿病史、血糖、ALT、AST、TG、WBC计数、HDL-C、EF与围绝经期女性发生CHD有关，HDL-C是围绝经期女性CHD发生的独立保护因素，可用于围绝经期女性发生CHD的早期预测。
Abstract:
Objective　To investigate the risk factors of coronary atherosclerotic heart disease(CHD) in perimenopausal women.
Methods　A total of 170 perimenopausal women admitted to Puyang People′s Hospital Affiliated to Xinxiang Medical University from October 2019 to December 2021 due to "chest pain,chest tightness" were selected as the study subjects.All subjects underwent coronary artery CT angiography or angiography,and the subjects were divided into CHD group (n=85) and non-CHD group (n=85) according to the examination results.The general data,alanine aminotransferase (ALT),aspartate aminotransferase(AST),blood glucose,triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),atherosclerosis index(LDL-C/HDL-C),blood urea nitrogen(BUN),uric acid(UA),creatinine(Cr),white blood cell(WBC) count,red blood cell(RBC) count,hemoglobin(Hb),hematocrit (HCT),mean red blood cell volume(MCV),red blood cell distribution width-standard deviation (RDW-SD),red blood cell distribution width-coefficient of variation (RDW-CV),platelet(PLT) count,platelet distribution width(PDW),mean platelet volume(MPV),plateletcrit (PCT),left ventricular end-diastolic diameter(LVDd) and ejection fraction (EF) of patients between the two groups were compared,their correlation with CHD in perimenopausal women were analyzed;the independent risk factors of CHD in perimenopausal women was analyzed by multivariate logistic regression analysis,and their diagnostic value for CHD was assessed by receiver operating characteristic(ROC) curve.
Results　The age,weight,history of hypertension,history of hyperlipidemia,TC,LDL-C,LDL-C/HDL-C,BUN,UA,Cr,RBC count,Hb,HCT,MCV,RDW-SD,RDW-CV,PLT count,PDW,MPV,PCT and LV were not associated with the occurrence of CHD in perimenopausal women (P>0.05).The history of diabetes mellitus at admission and levels of blood glucose,ALT,AST,TG,WBC count,HDL-C and EF of patients were associated with the occurrence of CHD in perimenopausal women (P<0.05).Multivariate logistic regression analysis showed that HDL-C was an independent protective factor for the development of CHD in perimenopausal women(OR=0.237,P<0.05).The area under curve(AUC) of ALT for predicting CHD in perimenopausal women was 0.673,95% confidence interval(CI) was 0.592-0.553,the sensitivity was 44.7%,the specificity was 81.2%,and the optimal cut point was 20.75 U·L-1 (P<0.01);the AUC of AST for predicting CHD in perimenopausal women was 0.616,95%CI was 0.531-0.701,the sensitivity was 49.4%,the specificity was 76.5%,and the optimal cut point was 20.75 U·L-1 (P<0.05);the AUC of blood glucose for predicting CHD in perimenopausal women was 0.550,95%CI was 0.463-0.637(P>0.05);the AUC of TG for predicting CHD in perimenopausal women was 0.602,95%CI was 0.517-0.687,the sensitivity was 51.8%,the specificity was 69.4%,and the optimal cut point was 1.765 mmol·L-1 (P<0.05);the AUC of HDL-C for predicting CHD in perimenopausal women was 0.642,95%CI was 0.559-0.725,the sensitivity was 20%,the specificity was 61.2%,and the optimal cut point was 1.765 mmol·L-1(P<0.05);the AUC of WBC count for predicting CHD in perimenopausal women was 0.62,95%CI was 0.536-0.704,the sensitivity was 72.9%,the specificity was 50.9%,and the optimal cut point was 5.325×109 L-1(P<0.05);the AUC of EF% for predicting CHD in perimenopausal women was 0.609,95%CI was 0.525-0.694,the sensitivity was 61.2%,the specificity was 17.6%,and the optimal cut point was 61.5%(P<0.05).
Conclusion　The history of diabetes,blood glucose,ALT,AST,TG,WBC count,HDL-C and EF are related to the occurrence of CHD in perimenopausal women.The HDL-C is an independent protective factor for the occurrence of CHD in perimenopausal women,which can be used for early prediction of the occurrence of CHD in perimenopausal women.

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更新日期/Last Update: 2023-02-05