東台灣男性急性心肌梗塞患者之危險因子

Risk Factors of Acute Myocardial Infarction in Male Inhabitants in Eastern Taiwan

李志偉(Chih-Wei Lee) ； 吳英黛(Ying-Tai Wu) ； 施教諭(Chiao-Yu Shih) ； 王志鴻(Ji-Hong Wang) ； 王豊裕(Li-Yu Wang) ； 謝仁哲(Jen-Jer Hsieh)

《台灣醫學》 12卷2期 (2008/03) Pp. 143-151

https://doi.org/10.6320/FJM.2008.12(2).01

摘要

流行病學研究顯示東台灣原住民族之心臟病盛行率高。本研究之目的為探討東台灣男性急性心肌梗塞患者以及正常冠狀動脈者成癮物使用（抽菸、嚼檳榔、飲酒）暨冠狀動脈危險因子（高血壓、糖尿病、血脂異常、肥胖）之原漢族別差異。以病歷調閱法，回顧1992年8月至2006年7月間住進花蓮慈濟醫學中心經心導管檢查之受檢者。依族別分成原住民族與漢民族，以心導管檢查證實冠狀動脈阻塞之男性第一次急性心肌梗塞發作患者（急性心肌梗塞群）以及源自心導管檢查資料之男性正常冠狀動脈者（正常冠狀動脈群）為對象群，以比較原漢族別，急性心肌梗塞群（原梗組；漢梗組）與正常冠狀動脈群（原正組；漢正組）二群四組間，成癮物使用組合暨冠狀動脈危險因子之差異。並以急性心肌梗塞有無為依變數，探討原漢族別罹患急性心肌梗塞之獨立變數勝算比（odds ratio, OR）與95%信賴區間(conference interval, CI)。計有881名患者參與本研究（原住民族80名、漢民族801名），其中急性心肌梗塞患者422名（原梗組41名、漢梗組381名）。成癮物使用因子現象，原住民族，飲酒及其相關組合呈較高值；漢民族，抽菸及其相關組合呈較高值。冠狀動脈危險因子現象，肥胖相關指標均於原住民族呈顯著高值。對漢民族而言，抽菸、高血壓、糖尿病以及總膽固醇對急性心肌梗塞發作之影響較為顯著，惟此現象未見於原住民族。原漢族別間主要顯著差異變數為飲酒、嚼檳榔、嚼檳榔與飲酒組合、成癮物使用以及肥胖，均於原住民族呈顯著高值。冠狀動脈危險因子之群間差異於漢民族顯著。

關鍵字

急性心肌梗塞 ； 正常冠狀動脈 ； 族群 ； 成癮物使用 ； 危險因子

並列摘要

Higher prevalence of cardiac diseases has been demonstrated for aborigines in eastern Taiwan relative to Han Chinese populations in Taiwan. The purpose of this study was to extend this work by determining the risks characteristics of male patients in eastern Taiwan with acute myocardial infarction (AMI) comparing the aborigines and Han Chinese samples. Based on retrospective review of the medical records for males patients who received cardiac catheterization were enrolled in this study. Subjects were classified into the aborigines and the Han Chinese groups. In each group, the subjects were classified into two subgroups based on AMI diagnosis and the results of a cardiac catheterization test: the + AMI+ group, defined by both AMI diagnosis and positive cardiac catheterization test findings; and, the -AMI- group, where there was neither diagnosis nor test findings, i.e., with a patent coronary artery. Difference in the elements of substance use (SU) and coronary risk factors (CRFs) were then statistically assessed comparing the aborigines and the Han Chinese groups. Further, the +AMI+ and -AMI- subgroups were also compared for these elements. A logistic regression model was used to provide odds ratios and 95% confidence intervals to test significant differences in AMI incidence. 881 individuals (80 in aborigines and 801 in Han Chinese) were included in this study. 422 individuals (41 in aborigines and 381 in Han Chinese) had a history of AMI. For the factors of SU, drinking and it's combined factors presented higher values in the aborigines. However, smoking and it's combined factors presented higher values in the Han Chinese. For the CRFs of AMI within distinct group, smoking, hypertension, diabetes, and total cholesterol showed significant relationships with AMI in the Han Chinese, but no factors in the aborigines. Between two groups, drinking, betel-nut, betel-nut combined with drinking, substance use, and obesity showed higher values in the aborigines. Within distinct group, only Han Chinese group presented statistically significant difference.

並列關鍵字

acute myocardial infarction ； patent coronary artery ； race ； substance use ； coronary risk factors