老年下肢动脉粥样硬化危险因素分析

Risk factors for atherosclerosis in the lower extremities in the elderly patients

摘要:

目的 探讨影响老年人下肢动脉粥样硬化疾病(LEAD)的相关危险因素。方法 连续性收集2013年5月1日至2014年12月31日内蒙古自治区人民医院血管外科及北京协和医院血管外科老年LEAD患者共98例(病例组),同时选取2个中心进行体检的老年健康人群70名作为对照组。收集2组患者基线资料及临床相关指标并进行比较。采用SPSS 19.0软件进行统计分析。根据数据类型,组间比较采用独立样本t检验或χ²检验。将单因素分析中P＜0.01的自变量纳入多因素logistic回归模型,分析影响老年LEAD的相关危险因素。结果 病例组患者男性、高血压、吸烟比例及收缩压水平显著高于对照组,舒张压和体质量指数水平显著低于对照组,差异有统计学意义(P＜0.05)。临床指标中,病例组患者空腹血糖(FBG)、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素、肌酐和高敏C-反应蛋白(hs-CRP)水平显著高于对照组,高密度脂蛋白胆固醇(HDL-C)及踝肱指数(ABI)水平显著低于对照组,差异均有统计学意义(P＜0.05)。多因素logistic回归分析显示,性别(OR=1.007,95%CI 0.201~1.232)、吸烟(OR=0.181,95%CI 0.044~1.119)、收缩压(OR=0.153,95%CI 0.135~0.198)、FBG(OR=3.226,95%CI 1.589~5.103)、HOMA-IR(OR=2.971,95%CI 1.456~4.716)、胰岛素(OR=1.996,95%CI 1.309~3.311)、HDL-C(OR=0.311,95%CI -0.237~0.515)、hs-CRP(OR=1.058,95%CI 0.313~1.157)和ABI(OR=-3.011,95%CI -4.238~-2.010)是发生LEAD的独立危险因素(P＜0.05)。结论 患有高血压或糖尿病的老年男性患者要注意LEAD的筛查,并积极戒烟,控制血压血糖,强化降脂。

Abstract:

To investigate the risk factors for lower extremity atherosclerosis disease (LEAD) in the elderly people. Methods Included as case group were 98 elderly LEAD patients treated in the Vascular Surgery of People′s Hospital in Inner Mongolia Autonomous Region and the Vascular Surgery of Peking Union Medical College Hospital from May 1,3 to December 31,4. At the same time, 70 healthy elderly people were enrolled as the control group who received check-ups at the 2 institutions. The baseline data and clinical indices of the 2 groups were collected and compared. SPSS statistics 19.0 was used for statistical analysis, and independent samples t test or χ² test, depending on data type, was used for comparison. The independent variables with P<0.01 in univariate analysis were included in a multiple logistic regression model to investigate the risk factors for LEAD in the elderly patients. Results The proportion of the male patients, the proportion of the smokers, hypertension rate, and systolic pressure in the case group were significantly higher than those in the control group, but diastolic pressure and body mass index were significantly lower (P<0.05). Of the clinical indices, fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), insulin, creatinine and high sensitivity C-reactive protein (hs-CRP) were significantly higher in the case group than in the control group, but the high-density lipoprotein cholesterol (HDL-C) and ankle brachial index (ABI) were significantly lower (P<0.05). Multiple factor logistic regression showed that sex (OR=1.007,5%CI 0.201-1.232), smoking (OR=0.181,5%CI 0.044-1.119), systolic pressure (OR=0.153, 95%CI 0.135-0.198), FBG (OR=3.226,5%CI 1.589-5.103), HOMA-IR(OR=2.971,5%CI 1.456-4.716), insulin(OR=1.996,5%CI 1.309-3.311), HDL-C(OR=0.311, 95%CI -0.237-0.515), hs-CRP(OR=1.058,5%CI 0.313-1.157)and ABI(OR=-3.011, 95%CI -4.238--2.010)were independent risk factors for LEAD (P<0.05). Conclusion Screening for LEAD should be emphasized in the elderly men with hypertension or diabetes, and they should be advised to quit smoking, control blood pressure and glucose, and reduce lipid.