人群血清促炎因子水平与心电图ST-T改变的相关性分析

摘要

目的：分析人群血清促炎因子水平、心电图ST-T改变、ROSE问卷心绞痛、代谢综合征的相互关系。方法：采用整群抽样方法，选取顺德桂洲镇马岗村35~59岁村民1100例进行横断面研究。对人群进行病史、冠心病ROSE问卷、身高、体重、腰围、血压、血脂、高敏C反应蛋白（hsCRP）、心电图检测。对样本按高敏C反应蛋白（hsCRP）水平高低、心电图ST-T改变的程度作分层分析。结果：资料完整、纳入分析的实际样本数为1093例。代谢综合征患病率为17.4％。人群平均hs-CRP水平为（3.46±1.14）mg/L，其中代谢综合征患者最高（4.72±0.38）mg/L，其余依次为ROSE问卷心绞痛患者（4.63±0.47）mg/L、心电图ST-T异常患者（4.38±0.72）mg/L，心电图无ST-T改变患者最低（3.21±0.89）mg/L，比较差异有统计学意义（P<0.05）。心电图异常患者、ROSE问卷心绞痛患者、代谢综合征患者与各自的正常患者比较，血清促炎因子hs-CRP水平较高，比较差异具有统计学意义（P<0.05）。心电图ST-T改变的总发生率为21.5％，心电图ST-T轻度改变的发生率为12.5％，心电图ST-T明显改变的发生率为9.0％。ROSE问卷心绞痛的检出率为15.2％，其中，心电图ST-T异常患者的Rose问卷心绞痛检出率为47.7％，显著高于心电图ST-T正常患者，比较差异有统计学意义（P<0.05）。心电图异常患者中，心电图异常越严重者，其血清促炎因子水平越高。血清促炎因子水平增高与心电图ST-T段异常存在明显的正相关关系。结论：血促炎因子水平升高可作为心血管疾病的预测手段。hsCRP检测结合Rose问卷及心电图ST-T改变，更有助于冠心病高危人群的筛选。%Objective:To evaluate the association among levels of serum proinflammatory factors,ST-T abnormalities on electrocardiogram (ECG),Rose questionnaire based angina pectoris,and Metabolic Syndrome in a rural population. Method:An analysis on the cross-sectional study data was performed,which 1100 subjects were sampled from a clustered sample of the total population (n=3000) in adults aged 35-59 years,from Guizhou Community,Shunde,Guangdong,in 2003. Demographic information,personal and family histories of diseases and Rose questionnaire were collected.Physical examination and laboratory tests included high-sensitivity C-reactive protein (hs-CRP) and serum lipids were done.Subjects underwent examination on resting 12-lead ECG.ECG tracings were coded with Minnesota Code and classified as ST-T abnormalities ECG or normal ST-T ECG,and ST-T abnormalities ECGs were classified as marked ST-T abnormalities ECG (codes 4-1,4-2, 5-1 and 5-2) or lesser degrees of ST-T abnormalities ECG (codes 4-3,4-4,5-3 and 5-4).Result:A total number of 1093 subjects (521 men and 572 women) were finally included in this analysis.The prevalence of Metabolic Syndrome was 17.4%.The average hs-CRP level was (3.46±1.14)mg/L.The Metabolic Syndrome patients had the highest mean hs-CRP level (4.72±0.38)mg/L followed by the Rose questionnaire based angina pectoris patients (4.63±0.47)mg/L,and then the ST-T abnormalities ECG patients (4.38±0.72)mg/L,successively.They had significantly higher hs-CRP level compared to the normal ST-T ECG patients (P<0.05),which had the lowest hs-CRP level (3.21±0.89)mg/L.ST-T abnormalities ECG patients,Rose questionnaire based angina pectoris patients and the Metabolic Syndrome patients had significantly higher hs-CRP levels compared with their respective normal patients (P<0.05).The standardized prevalence of ST-T abnormalities ECG was 21.5% (9.0% in marked ST-T abnormalities ECG group and 12.5% in lesser degrees of ST-T abnormalities ECG group).The prevalence of Rose angina was 15.2%.The prevalence of Rose angina was significantly higher in ST-T abnormalities ECG group (47.7%) than in normal ST-T ECG patients(P<0.05).It was found that the severer the ST-T abnormalities,the higher the hs-CRP levels in abnormal ST-T patients (P<0.05).The level of hs-CRP positively correlated with ST-T abnormalities.Conclusion:Level of serum proinflammatory factors is predictors of cardiovascular diseases.It is a contributor to detecting subjects at high risk of coronary heart diseases with hs-CRP combining ECG ST-T abnormalities and Rose questionnaire.