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中华卫生应急电子杂志 ›› 2018, Vol. 04 ›› Issue (04) : 204 -211. doi: 10.3877/cma.j.issn.2095-9133.2018.04.002

所属专题: 文献

论著

新疆维吾尔自治区克州地区三个民族急性心肌梗死患者的危险因素分析
苏玉娟1, 李春雨2, 姜婷3, 毕超4, 赵鹏程4, 陈君5, 曹瑞莹4, 陈彦6, 王魏魏3,()   
  1. 1. 845350 新疆维吾尔自治区,新疆维吾尔自治区疏勒县69216部队卫生队
    2. 210036 江苏南京,江苏省妇幼保健院重症医学科
    3. 210029 江苏南京,南京医科大学第一附属医院重症医学科
    4. 210029 江苏南京,南京医科大学第一附属医院急诊中心
    5. 210006 江苏南京,南京医科大学附属南京市第一医院急诊中心
    6. 210029 江苏南京,南京医科大学第一附属医院急诊中心;845350 新疆维吾尔自治区,克孜勒苏柯尔克孜自治州人民医院医务部
  • 收稿日期:2018-07-25 出版日期:2018-08-18
  • 通信作者: 王魏魏

Analysis of risk factors of acute myocardial infarction patients in three ethnic groups in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region

Yujuan Su1, Chunyu Li2, Ting Jiang3, Chao Bi4, Pengchen Zhao4, Jun Chen5, Ruiying Cao4, Yan Chen6, Weiwei Wang3,()   

  1. 1. 69216 Army health team, shule county of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region 845350, China
    2. Intensive Care Unit, Women and Children Health Care Hospital of Jiangsu Province, Nanjing 210036, China
    3. Intensive Care Unit, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    4. Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    5. Emergency Center, The Affiliated Nanjing First Hospital of Nanjing Medical University, Nanjing 210006, China
    6. Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Medical Department, Kizilsu Kirgiz Autonomous Prefecture People’s Hospital, Xinjiang Uygur Autonomous Region 845350, China
  • Received:2018-07-25 Published:2018-08-18
  • Corresponding author: Weiwei Wang
  • About author:
    Corresponding author: Wang Weiwei, Email:
引用本文:

苏玉娟, 李春雨, 姜婷, 毕超, 赵鹏程, 陈君, 曹瑞莹, 陈彦, 王魏魏. 新疆维吾尔自治区克州地区三个民族急性心肌梗死患者的危险因素分析[J/OL]. 中华卫生应急电子杂志, 2018, 04(04): 204-211.

Yujuan Su, Chunyu Li, Ting Jiang, Chao Bi, Pengchen Zhao, Jun Chen, Ruiying Cao, Yan Chen, Weiwei Wang. Analysis of risk factors of acute myocardial infarction patients in three ethnic groups in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2018, 04(04): 204-211.

目的

分析新疆维吾尔自治区克州地区三个民族(汉族、维吾尔族和柯尔克孜族)急性心肌梗死(AMI)患者的临床特征,评估影响患者死亡率的危险因素。

方法

收集2016年1月至2017年11月在新疆维吾尔自治区克州人民医院心血管内科明确诊断为AMI并行冠状动脉造影手术患者的临床数据进行回顾性研究,分析患者的人口统计学资料、民族、基础疾病、血液及生化指标、冠脉造影结果、预后情况等。再根据患者的临床转归分为生存组和死亡组,通过Logistic回归模型分析,确定影响三个民族AMI患者死亡率的危险因素。统计描述与数据分析均应用SPSS 22.0统计分析软件完成。

结果

共纳入175例AMI患者,其中汉族41例、柯族47例、维族87例。25人最终死亡,汉族、柯族和维族的死亡率分别为12.19%、17.02%、13.79%,三个民族死亡率无明显统计学差异。少数民族AMI患者饮酒率高于汉族患者,差异具有统计学意义(P<0.05)。少数民族患者的收缩压(SBP)水平(P<0.05)、舒张压(DBP)水平(P<0.05)、血白细胞(WBC)计数(P<0.001)、血中性粒细胞比值(NE%)(P<0.05)和血清肌钙蛋白T(cTNT)水平(P<0.001)高于汉族患者,而血红蛋白(HB)水平(P<0.05)低于汉族患者。56.10%的汉族AMI患者是多支冠脉血管病变,比例高于柯族和维族患者(P<0.05)。Logistic回归分析发现血浆纤维蛋白原(FIB)水平(P<0.05)、血红细胞(RBC)计数(P<0.05)和发生多支冠脉血管病变(P<0.05)是影响三个民族患者死亡率的危险因素。

结论

新疆维吾尔自治区克州地区少数民族患者和汉族患者在饮酒率和发生AMI时血压、WBC、NE%、HB、cTNT升高水平以及冠脉病变血管数方面存在差异性,血浆FIB水平、血RBC计数和发生多支冠脉血管病变是影响三个民族AMI死亡率的重要危险因素。

Objective

To analyze the clinical characteristics profile of Han, Uygur and Khalkhas patients with acute myocardial infarction (AMI) and assess the risk factors affecting the mortality of patients in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region.

Methods

A retrospective study was conducted among the patients diagnosed with AMI between January 2016 and November 2017 in the cardiovascular medicine department of Kizilsu Kirgiz Autonomous Prefecture People’s Hospital and performed coronary angiography. Data on demographic characteristics, ethnic groups, underlying diseases, blood and biochemical indices, coronary angiographic results and clinical outcome were collected. The differences of clinical characteristics among the AMI patients of the three ethnic groups were compared. According to the clinical outcome, the patients were divided into survivor and non-survivor groups. The risk factors affecting the mortality of patients of the three ethnic groups were identified by Logistic regression analysis. All statistical description and analysis was conducted by SPSS 22.0.

Results

175 AMI patients were collected, of which the number of Han patients was 41, the number of Khalkhas patients was 47 and the number of Uygur patients was 87. 25 patients were dead finally. The mortality rate of Han, Khalkhas and Uygur patients was 12.19%, 17.02% and 13.79%, respectively. There was no statistical significance among the mortality rates of three ethnic groups. The drinking rate of ethnic minorities AMI patients was higher than that of Han group. The difference was statistically significant (P<0.05). As the same, the systolic blood pressure (SBP) levels (P<0.05), diastolic blood pressure (DBP) levels (P<0.05), white blood cell (WBC) count (P<0.001), neutrophilic granulocyte (NE)% (P<0.05) and serum cardiac troponin T (cTNT) levels (P<0.001) of ethnic minority patients were higher than that of Han group. But the hemoglobin (HB) levels of ethnic minority patients was lower than that of Han group (P<0.05). 56.10 % of Han AMI patients had combined with multi-vessel coronary artery infarction and the proportion was higher than that of ethnic minority patients (P<0.05). In Logistic regression analysis, the risk factors affecting mortality were the plasma fibrinogen (FIB) levels (P<0.05), red blood cell (RBC) count (P<0.05) and multi-vessel coronary artery infarction (P<0.05).

Conclusion

There were differences in drinking rate and increased levels of blood pressure, WBC, NE%, HB, cTNT and the number of vessels in coronary artery infarction at the time of AMI between ethnic minority groups and Han group in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. The plasma FIB levels, RBC count and multi-vessel coronary artery infarction were the important risk factors responsible for mortality of AMI in three ethnic groups.

表1 三个民族175例AMI患者一般资料及临床特征
组别 例数(例) 年龄(±s,岁) 男性[例(%)] BMI[median(IQR),kg/m2] 吸烟史[例(%)] 饮酒史[例(%)]
汉族 41 58.02±10.69 36(87.8) 22(20~24) 19(46.3) 4(9.8)
柯族 47 59.40±10.99 41(87.2) 23(21~24) 31(66.0) 16(34.0)
维族 87 58.60±12.29 67(77.0) 22(20~25) 56(64.4) 23(26.4)
F ? 0.16 ? 1.36 ? ?
P ? >0.05 >0.05 >0.05 >0.05 <0.05
组别 例数(例) 既往PCI史[例(%)] 冠心病家族史[例(%)] 高血压病[例(%)] 糖尿病[例(%)] 慢性肾病[例(%)]
汉族 41 0(0.0) 8(19.5) 10(24.4) 10(24.4) 1(2.4)
柯族 47 4(8.5) 13(27.7) 16(34.0) 5(10.6) 2(4.3)
维族 87 3(3.4) 25(28.7) 29(33.3) 14(16.1) 4(4.6)
P ? >0.05 >0.05 >0.05 >0.05 >0.05
组别 例数(例) 脑血管病[例(%)] 高甘油三酯血症[例(%)] 高胆固醇血症[例(%)] SBP[median(IQR),mmHg] DBP[median(IQR),mmHg]
汉族 41 10(24.4) 3(7.3) 13(31.7) 120(100~133) 70(60~89)
柯族 47 7(14.9) 6(12.8) 19(40.4) 120(110~130) 75(70~80)
维族 87 19(21.8) 12(13.8) 25(28.7) 125(110~140) 80(70~90)
F ? ? ? ? 3.67 3.17
P ? >0.05 >0.05 >0.05 <0.05 <0.05
组别 例数(例) TC[median(IQR),mmol/L] TG[median(IQR),mmol/L] LDL~C(±s,mmol/L) HDL~C[median(IQR),mmol/L] LP(a)[median(IQR),mg/L]
汉族 41 3.95(3.31~4.80) 1.39(1.15~2.06) 2.69±0.91 1.10(0.93~1.21) 114.05(64.20~256.30)
柯族 47 4.39(3.80~4.88) 1.64(1.28~2.08) 2.61±0.85 0.97(0.83~1.26) 119.50(67.55~293.50)
维族 87 4.37(3.67~4.79) 1.50(1.16~2.01) 2.91±0.90 1.10(0.99~1.34) 168.50(78.50~348.95)
F ? 1.78 0.18 1.71 1.71 2.09
P ? >0.05 >0.05 >0.05 >0.05 >0.05
组别 例数(例) 载脂蛋白a(±s,mmol/L) 载脂蛋白b(±s,mmol/L) 尿酸(±s,,μmol/L) Cr[median(IQR),μmol/L] CRP[median(IQR),mg/L]
汉族 41 0.97±0.21 0.92±0.27 302.25±78.97 91.30(81.80~102.31) 5.56(3.45~21.30)
柯族 47 0.87±0.26 0.98±0.23 331.07±102.99 95.90(83.60~106.10) 6.24(4.35~72.25)
维族 87 0.97±0.20 0.92±0.23 305.47±96.47 93.10(82.70~103.50) 12.20(3.01~31.59)
F ? 2.87 0.97 1.38 0.28 1.46
P ? >0.05 >0.05 >0.05 >0.05 >0.05
组别 例数(例) Hcy[median(IQR),μmol/L] FIB[median(IQR),g/L] WBC[median(IQR),*10^9/L] NE%[median(IQR),%] RBC[median(IQR),*10^12/L]
汉族 41 11.10(6.55~15.58) 2.81(2.34~3.43) 5.86(4.66~7.24) 67.58(65.36~73.31) 4.16(3.68~4.51)
柯族 47 11.90(9.30~15.20) 3.25(2.63~3.95) 6.89(5.65~8.21) 69.68(67.38~76.35) 4.16(3.67~4.56)
维族 87 11.20(8.75~14.60) 2.94(2.34~3.82) 7.85(6.95~8.69) 68.35(63.25~73.26) 4.12(3.68~4.54)
F ? 0.26 2.02 4.53 3.19 0.35
P ? >0.05 >0.05 <0.001 <0.05 >0.05
组别 例数(例) HB[median(IQR),g/L] PLT(±s,*10^9/L) cTNT[median(IQR),ng/L] ? ?
汉族 41 156(136~167) 198.12±59.14 1.20(0.77~1.56) ? ?
柯族 47 146(135~168) 209.11±60.92 2.36(1.35~4.23) ? ?
维族 87 145(135~152) 198.40±66.41 1.56(0.99~3.22) ? ?
F ? 3.27 0.50 17.94 ? ?
P ? <0.05 >0.05 <0.001 ? ?
表2 三个民族AMI患者冠脉造影结果比较[例,(%)]
表3 影响AMI患者转归的一般资料及临床特征
组别 例数(例) 年龄(±s,岁) 男性[例(%)] 汉族(%) BMI[median(IQR),kg/m2] 吸烟史[例(%)] 饮酒史[例(%)] 高血压病[例(%)]
死亡组 25 62.44±13.89 22(88.0) 20.0 22(20-25) 18(72.0) 9(36.0) 10(40.0)
生存组 150 58.05±11.03 122(81.3) 24.0 22(20-24) 88(58.7) 34(22.7) 45(30.0)
P ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
OR(95%CI)值 ? 1.03(0.99-1.07) 0.59(0.17-2.13) 0.79(0.23-2.26) 1.03(0.87-1.23) 0.55(0.22-1.40) 0.52(0.21-1.28) 0.64(0.27-1.54)
组别 例数(例) 糖尿病[例(%)] 高甘油三酯血症[例(%)] 高胆固醇血症[例(%)] SBP[median(IQR),mmHg] DBP[median(IQR),mmHg] TC[median(IQR),mmol/L] TG[median(IQR),mmol/L]
死亡组 25 5(20.0) 9(36.0) 3(12.0) 120(105-130) 80(70-80) 4.21(3.62-4.93) 1.40(1.17-2.41)
生存组 150 24(16.0) 48(32.0) 18(12.0) 120(110-140) 80(70-84) 4.31(3.60-4.79) 1.50(1.18-2.03)
P ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
OR(95%CI)值 ? 0.76(0.26-2.23) 0.84(0.35-2.03) 1.00(0.27-3.68) 0.99(0.98-1.02) 1.00(0.97-1.03) 0.96(0.65-1.44) 1.17(0.71-1.93)
组别 例数(例) LDL-C(±s,mmol/L) HDL-C[median(IQR),mmol/L] Cr[median(IQR),μmol/L] CRP[median(IQR),mg/L] Hcy[median(IQR),μmol/L] FIB[median(IQR),g/L] WBC[median(IQR),*10^9/L]
死亡组 25 2.65±0.77 1.04(0.80-1.27) 95.20(82.45-110.75) 5.31(2.24-49.08) 13.60(9.80-22.50) 3.41(3.02-5.18) 7.26(6.29-9.56)
生存组 150 2.80±0.93 1.10(0.93-1.30) 93.10(82.18-103.17) 8.42(3.56-30.02) 11.10(8.60-14.05) 2.91(2.39-3.66) 7.26(6.35-8.26)
P ? >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 >0.05
OR(95%CI)值 ? 0.82(0.49-1.37) 0.54(0.12-2.37) 1.01(0.99-1.02) 1.00(0.98-1.02) 1.03(0.99-1.07) 1.48(1.07-2.03) 1.03(0.94-1.12)
组别 例数(例) NE%[median(IQR),%] RBC[median(IQR),*10^12/L] HB[median(IQR),g/L] PLT(±s,*10^9/L) cTNT[median(IQR),ng/L] 多支血管病变[例(%)] ?
死亡组 25 70.32(68.17-76.47) 5.26(4.85-6.91) 145(135-160) 194.64±57.25 1.35(0.99-3.00) 12(48.0) ?
生存组 150 69.35(65.35-74.73) 4.16(3.68-4.55) 145(135-165) 202.31±64.19 1.56(0.97-2.78) 47(31.3) ?
P ? >0.05 <0.05 >0.05 >0.05 >0.05 <0.05 ?
OR(95%CI)值 ? 1.03(0.97-1.09) 2.18(1.84-2.53) 0.99(0.97-1.02) 0.99(0.99-1.01) 0.92(0.68-1.24) 1.53(1.31-1.74) ?
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