目的:探讨高龄老年人群（≥75岁）发生冠心病的主要危险因素及构建相应的诊断模型。方法:回顾分析上海交通大学医学院附属瑞金医院2018年6月至2019年12月期间拟诊冠心病而接受冠状动脉造影（coronary angiography,CAG）检查的高龄老年（≥75岁）患者548例,根据CAG结果分为冠心病组及对照组,采用多因素Logistic回归模型分析其危险因素,并用受试者操作特征（receiver operator characteristic,ROC）曲线评价这些因素对高龄老年人发生冠心病的预测价值。结果:对冠心病组及对照组进行基线分析后,构建多因素Logistic回归分析模型。多因素Logistic回归分析结果提示,肌钙蛋白I 水平升高[优势比（odds ratio,OR）=6.828,95%置信区间（confidence interval,CI）为 3.834~12.160,P<0.001）、颈动脉斑块形成（OR=3.440,95%CI为1.780~6.650,P<0.001）、糖化血红蛋白水平升高（OR=1.532,95%CI为1.182~1.987,P=0.001）和白细胞计数升高（OR=1.187,95%CI为1.027~1.371,P=0.021）是高龄老年人罹患冠心病的危险因素,而女性（OR=0.329,95%CI为0.201~0.538,P<0.001）、直接胆红素水平升高（OR=0.800,95%CI为0.679~0.942,P=0.008）、血红蛋白水平升高（OR=0.976,95%CI为0.960~0.992,P=0.003）为保护因素。根据以上7个因素构建ROC曲线的曲线下面积为0.825（P<0.05）,显示其诊断效能良好。结论:与冠心病全人群的危险因素（如糖尿病、高血压、吸烟、高脂血症、肥胖、高同型半胱氨酸血症）不同,本研究发现肌钙蛋白I水平升高、颈动脉斑块形成是高龄老年人发生冠心病的主要危险因素,而女性则是高龄老年人群发生冠心病潜在的保护因素。建立相应的ROC曲线诊断模型,从拟诊冠心病患者人群中识别冠心病高危患者,可减少过度使用CAG检查。

Objective: To investigate the major risk factors for coronary heart disease (CHD) in elderly patients (≥75 years old) using coronary angiography and develop relevant diagnostic model. Methods: Retrospective analysis was conduc-ted on 548 elderly patients with suspected diagnosis of CHD(≥75 years old) underwent coronary angiography (CAG) treatment in Ruijin Hospital from June 2018 to December 2019. According to CAG results, the patients were divided into two groups :CHD group and control group. The risk factors were analyzed by multivariate Logistic regression, and the predictive value of these factors for the occurrence of CHD in the elderly was evaluated by receiver operator characteristic curve (ROC curve). Results: There were 408 cases in the CHD group and 140 cases in the control group based on results of CAG. The multivariate Logistic regression analysis after baseline analysis showed that elevated level of troponin I(OR=6.828, 95%CI:3.834-12.160, P<0.001), carotid plaque formation(OR=3.440, 95%CI: 1.780-6.650, P<0.001), elevated level of HbA1c(OR=1.532, 95%CI: 1.182-1.987, P=0.001) and white blood cell (WBC) counts (OR=1.187, 95%CI: 1.027-1.371, P=0.021) were risk factors for elderly patients with CHD, While female(OR=0.329, 95%CI: 0.201-0.538, P<0.001), elevated level of direct bilirubin(OR=0.800, 95%CI: 0.679-0.942, P=0.008) and elevated level of hemoglobin(OR=0.976, 95%CI: 0.960-0.992, P=0.003) were protective factors for CHD in elderly patients. The area under the curve of the ROC curve model established with above 7 factors for recognizing CHD in elderly patients was 0.825(P<0.05), with a good diagnostic performance. Conclusions:Unlike the risk factors established among the whole population, such as diabetes, high blood pressure, smoking, hyperlipidemia, obesity and high homocysteine, the increased level of troponin I and carotid artery plaque formation are major risk factors for CHD in the elderly. However, the female gender are potential protective factors for CHD. The corresponding diagnostic model is of certain value for identifying high-risk patients from patients suspected of CHD, and may help reduce excessive and unreasonable use of CAG.