张宜锦

[摘要] 目的：探讨不同血脂和脂蛋白水平在中年人缺血性心血管病事件中的预测作用。方法：选择2001年1月~2009年4月来我院体检的经随访发现缺血性心血管事件的35例患者为观察组，对其血脂指标进行分析，并将其与对照组（未发生心血管事件的体检者）进行对比。结果：随访期间，缺血性心血管病的发生与年龄、收缩压（SBP）、舒张压（DBP）、血清总胆固醇（TC）、三酰甘油（TG）、血糖、体重指数（BMI）、吸烟、饮酒相关，观察组与对照组比较，差异有统计学意义（P<0.05）；在排除了年龄、SBP、DBP、血糖、吸烟、饮酒等主要心血管病危险因素后，经Cox分析表明，TC为5.17~5.67、5.68~6.19、＞6.19 mmol/L时发生缺血性心血管病的相对危险度分别为1.35，1.66和1.70；低密度脂蛋白胆固醇（LDL-C）为3.62~4.12、＞4.12 mmol/L时发生缺血性心血管病的相对危险度分别1.63和1.68。TC为5.17~5.67 mmol/L和≥5.68 mmol/L时的归因危险度百分比分别为34.3%和34.6%，LDL-C为2.58~3.61mmol/L和≥3.62 mmol/L时的归因危险度百分比分别为34.4%和35.9%，与TC接近。结论：中年人血清TC及LDL-C水平与心血管事件的发生相关，控制血脂水平可有效减少缺血性心血管事件的发生。

[关键词] 血脂；脂蛋白；中年人；缺血性心血管病

[中图分类号] R54 [文献标识码] C [文章编号]1673-7210（2011）11（c）-148-03

The predictive effects of different lipid level on the incidence of ischemic cardiovascular disease in middle aged people

ZHANG Yijin

Department of Cardiology, Geriatric Hospital of Xuzhou City, Jiangsu Province, Xuzhou 221003, China

[Abstract] Objective: To investigate the predictive effects of different lipid level on the incidence of ischemic cardiovascular disease in middle aged people. Methods: From January 2001 to April 2009, 35 cases of patients who were diagnosed with ischemic cardiovascular disease in our hospital were selected as observation group, lipids indexs of observation group were analyzed and compared with control group (no cardiovascular events patients who were take physical examination in our hospital). Results: During follow-up time, the incidence of ischemic cardiovascular disease were related with age, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum total cholesterol (TC), triglyceride (TG), glucose, body mass index (BMI), smoking and alcohol, which were compared between the observation group and the control group, the differences were statistically significant (P<0.05). The Cox analysis showed that the relative risks of ischemic cardiovascular disease occurrence were 1.35, 1.66 and 1.70 when TC in 5.17-5.67 mmol/L, 5.68-6.19 mmol/L, ＞6.20 mmol/L. The relative risks of ischemic cardiovascular disease occurrence were 1.63,1.68 when low-density lipoprotein cholesterol (LDL-C) in 3.62-4.12 mmol/L and ＞4.12 mmol/L. The attributable risk proportion were 34.3% and 34.6% respectively when TC in 5.17-5.67mmol/L and ≥5.68 mmol/L, the attributable risk proportion were 34.4% and 35.9% when LDL-C in 2.58-3.61mmol/L and ≥3.62 mmol/L, which were close to the TC values. Conclusion: Serum TC and LDL-C levels of middle aged people are related to cardiovascular events. Control blood lipid levels can reduce the incidence of ischemic cardiovascular events.

[Key words] Lipids; Lipoproteins; Middle aged people; Ischemic cardiovascular disease

近年来，我国心血管事件的发生有上升的趋势，且越来越趋于年轻化，同时此类患者的血脂异常检出率明显增高，因此，临床上逐渐重视对血脂异常患者的防治[1]。目前，关于血脂异常是否为心血管事件发生危险因素的报道甚少。笔者就本院近年来发现的缺血性心血管事件病例进行回顾性分析，为不同血脂和脂蛋白指标在中年人缺血性心血管病事件中的预测提供证据。

1 资料与方法

1.1 一般资料

对2001年1月~2009年4月于本院体检的836名职工资料进行回顾性分析，其中，男435例，女401例；年龄35~55岁；均无心肌梗死及脑卒中病史。所有患者随访2~5年，平均3.2年，随访期间发生缺血性心血管事件35例，将其作为观察组，其中，男19例，女16例；缺血性脑卒中17例，单纯性冠心病9例，冠心病合并缺血性脑卒中9例。将观察组患者的体检资料进行整理，分析人群中发生缺血性心血管病事件的不同血脂水平状况。……