第六章 第六章
第六章 結論結論結論結論
本研究顯示，吸菸和飲酒與罹患冠狀動脈心臟病之相關相當強，有 吸菸習慣者對於罹患冠狀動脈心臟病之風險有關，而有飲酒習慣則會對 於罹患冠心病有其保護作用。其它冠心病傳統危險因子，如高血壓、血 脂異常、年長與男性，由本研究再度證實會增加冠狀動脈心臟病之危險 性。
MnSOD、CAT 和 GPx1 三個抗氧化壓力基因型與冠心病之間，只有 發現 MnSOD 基因型與冠狀動脈心臟病風險有關。但進一步觀察後發現，
MnSOD、CAT 基因變異型在年輕族群罹病風險有增加趨勢，三基因變異 型數量與冠心病之間，有劑量關係效應存在，擁有變異型對偶基因愈多 者罹病之危險性愈高。另一方面，蛋白質羰基濃度與冠心病之間亦無顯 著相關，但與影響氧化壓力之環境因子暴露有關。
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表一 冠狀動脈心臟病研究對象之人口基本變項分布
表二 冠狀動脈心臟病研究對象之生活習慣分布
生活習慣
Cases, n (%) N=663
Controls, n (%)
N=413 p-value a BMI mean (SD), kg/m2 25.1(4.0) 25.6(3.9) 0.06
BMI 0.20
＜18.5 22(3.4) 14(3.4)
18.5 ~ 24 237(36.2) 123(29.9)
24 ~ 27 209(32.0) 143(34.8)
＞27 186(28.4) 131(31.9)
吸菸狀態 <0.001
不曾 302(45.8) 251(60.9)
有吸菸 276(41.8) 121(29.4)
已戒菸 82(12.4) 40(9.7)
吸菸量(包/天) <0.001
0 302(58.0) 251(71.1)
<1 63(12.1) 34(9.6)
≧ 1 156(29.9) 68(19.3)
喝酒狀態 0.15
不曾 513(78.2) 298(73.2)
有喝酒 137(20.9) 106(26.0)
已戒酒 6(0.9) 3(0.8)
a 連續變項用 t-test；類別變項用 Chi-square test
表三 冠狀動脈心臟病研究對象之各項生化指標
Normal 360(65.0) 288(78.9)
Unmoral 179(35.0) 77(21.1)
尿酸 mean ± SD,mg/dl 8.0 ± 2.0 7.3 ± 2.2 ＜0.001
Normal 456(76.6) 240(75.0)
Unmoral 139(23.4) 80(25.0)
低密度脂蛋白 mean ± SD,mg/dl 172.2 ± 43.6 160.4 ± 46.0 ＜0.001
表四 冠狀動脈心臟病研究對象之健康情形分佈
表五 依冠狀動脈阻塞程度分組比較人口基本變項和生化指標
表六 冠狀動脈心臟病和生活習慣相關之勝算比
生活習慣 Cases, n (%) Controls, n (%) OR(95%CI) OR(95%CI)a BMI, kg/m2
＜18.5 22(3.4) 14(3.4) 0.82(0.40-1.65) 0.65(0.31-1.38)
18.5 ~ 24 237(36.2) 123(29.9) 1.0 1.0
24 ~ 27 209(32.0) 143(34.8) 0.76(0.56-1.03) 0.85(0.62-1.18)
＞27 186(28.4) 131(31.9) 0.74(0.54-1.01) 0.96(0.69-1.33) 吸菸狀態
不曾 302(45.8) 251(60.9) 1.0 1.0
有吸菸 276(41.8) 121(29.4) 1.90(1.45-2.49)* 2.04(1.48-2.82)*
已戒菸 82(12.4) 40(9.7) 1.70(1.13-2.58)* 1.39(0.88-2.20) 吸菸量(包/天)
0 302(58.0) 251(71.1) 1.0 1.0
<1 63(12.1) 34(9.6) 1.54(0.98-2.41) 1.38(0.85-2.23)
≧ 1 156(29.9) 68(19.3) 1.91(1.37-2.65)* 2.17(1.48-3.20)*
喝酒狀態
不曾 513(78.2) 298(73.2) 1.0 1.0
有喝酒 137(20.9) 106(26.0) 0.75(0.56-1.00) 0.67(0.48-0.92)*
已戒酒 6(0.9) 3(0.8) 1.16(0.29-4.68) 1.44(0.30-5.52)
a 調整年齡、性別.
* p＜0.05
表七 冠狀動脈心臟病研究對象和共病狀況之勝算比
健康狀況 Cases, n (%) Controls, n (%) OR(95%CI) OR(95%CI)a 高血壓
Yes 353(53.2) 171(41.4) 1.61(1.26-2.07)* 1.51(1.16-1.95)*
No 310(46.8) 242(58.2) 1.0 1.0
糖尿病
Yes 239(36.1) 66(16.0) 2.96(2.18-4.03)* 2.99(2.17-4.13)*
No 424(63.9) 347(84.0) 1.0 1.0
高脂血症
Yes 101(15.2) 51(12.4) 1.28(0.89-1.83) 1.36(0.93-1.98)
No 562(84.8) 362(87.6) 1.0 1.0
腎衰竭
Yes 52(7.8) 19(4.6) 1.76(1.03-3.03)* 1.55(0.88-2.73)
No 611(92.2) 394(95.4) 1.0 1.0
痛風
Yes 124(18.7) 65(15.7) 1.23(0.89-1.71) 1.07(0.76-1.51)
No 539(81.3) 348(84.3) 1.0 1.0
慢性肝炎
Yes 31(4.7) 25(6.0) 0.76(0.44-1.31) 0.87(0.49-1.52)
No 632(95.3) 388(94.0) 1.0 1.0
消化性潰瘍
Yes 69(10.4) 67(16.2) 0.60(0.42-0.86)* 0.52(0.36-0.77)*
No 597(89.6) 346(83.8) 1.0 1.0
慢性阻塞肺部疾病
Yes 45(6.8) 17(4.1) 1.70(0.96-3.00) 0.98(0.54-1.78)
No 618(93.2) 391(95.9) 1.0 1.0
手術
Yes 179(27.0) 137(33.2) 0.75(0.57-0.97)* 0.75(0.56-0.99)*
No 484(73.0) 276(66.8) 1.0 1.0
a 調整年齡、性別.
* p＜0.05
表八 冠狀動脈心臟病研究對象依生化指標分組之勝算比
生化指標 Cases, n (%) Controls, n (%) OR(95%CI) OR(95%CI)c 肌酐酸a, mg/dl
Normal 360(65.0) 288(78.9) 1.0 1.0
Unmoral 179(35.0) 77(21.1) 2.01(1.49-2.72)* 1.66(1.21-2.27)*
尿酸, mg/dl
<8.0 335(58.7) 218(67.1) 1.0 1.0
>8.0 236(41.3) 107(32.9) 1.44(1.08-1.91)* 1.27(0.95-1.72) 高密度脂蛋白b, mg/dl
Normal 456(76.6) 240(75.0) 1.0 1.0
Unmoral 139(23.4) 80(25.0) 0.91(0.67-1.26) 0.76(0.54-1.06) 低密度脂蛋白, mg/dl
＜130 92(15.5) 82(25.6) 1.0 1.0
130 ~ 159 145(24.4) 76(23.7) 1.70(1.13-2.56)* 1.68(1.10-2.58)*
160 ~ 189 174(29.2) 85(26.6) 1.83(1.23-2.71)* 1.92(1.27-2.90)*
≧190 184(30.9) 77(24.1) 2.13(1.43-3.18)* 2.49(1.64-3.80)*
膽固醇, mg/dl
＜200 145(22.5) 122(32.4) 1.0 1.0
200 ~ 239 191(29.6) 124(33.0) 1.30(0.93-1.80) 1.38(0.97-1.96)
≧240 309(47.9) 130(34.6) 2.00(1.46-2.74)* 2.52(1.78-3.54)*
三酸甘油酯, mg/dl
＜200 422(65.6) 281(76.1) 1.0 1.0
200 ~ 400 157(24.4) 66(17.9) 1.58(1.15-2.19)* 1.81(1.29-2.55)*
≧400 64(10.0) 22(6.0) 1.94(1.17-3.22)* 2.63(1.55-4.46)*
極低密度脂蛋白, mg/dl
表九 冠狀動脈心臟病危險因子之多變項邏輯斯迴歸分析
表十 冠狀動脈心臟病研究對象之氧化壓力基因型分佈情形
基因型
Cases, n (%) N=465
Controls, n (%)
N=217 p-valueb
MnSOD
Val/Val 369(79.3) 188(86.6) 0.06
Ala/Val 85(18.3) 27(12.4)
Ala/Ala 11(2.4) 2(1.0)
Val/Val 369(79.3) 188(86.6) 0.02
With Alaa 96(20.6) 29(13.4)
CAT
C/C 420(90.5) 203(94.0) 0.25
C/T 42(9.1) 13(6.0)
T/T 2(0.4) 0(0)
C/C 420(90.5) 203(94.0) 0.13
C/T＋T/T 44(9.5) 13(6.0)
GPx1
Pro/Pro 414(91.0) 193(91.0) 0.98
Pro/Leu 41(9.0) 19(9.0)
a Val/Ala + Ala /Ala
b Chi-square test
表十一 冠狀動脈心臟病研究對象依氧化壓力基因型分組之勝算比
基因型
Cases, n (%) N=465
Controls, n (%)
N=217 OR(95%CI) OR(95%CI)a MnSOD
Val/Val 369(79.3) 188(86.6) 1.0 1.0
Val/Ala 85(18.3) 27(12.4) 1.60(1.01-2.56)* 1.78(1.01-3.12)*
Ala/Ala 11(2.4) 2(1.0) 2.80(0.62-12.8) 2.09(0.41-10.6) With Ala b 96(20.6) 29(13.4) 1.69(1.07-2.65)* 1.81(1.05-3.10)*
CAT
C/C 420(90.5) 203(94.0) 1.0 1.0
C/T 42(9.1) 13(6.0) 1.56(0.82-2.97) 1.37(0.64-2.93)
T/T 2(0.4) 0(0) － －
C/T+T/T 44(9.5) 13(6.0) 1.64(0.86-3.10) 1.42(0.67-3.03) GPx1
Pro/Pro 414(91.0) 193(91.0) 1.0 1.0
Pro/Leu 41(9.0) 19(9.0) 1.01(0.57-1.78) 1.21(0.60-2.43)
a 調整年齡、性別、抽菸習慣、喝酒習慣、膽固醇、HDL
b Val/Ala +Ala/Ala
* p < 0.05
表十二 冠狀動脈阻塞程度與氧化壓力基因型之相關性
冠狀動脈阻塞程度a
基因型 0 1 2 3
MnSOD
Val/Val 188 127 107 135
With Alab 29 40 27 29
OR(95%CI) 1.0 2.04(1.20-3.46)* 1.64(0.92-2.91) 1.39(0.80-2.44) OR(95%CI)c 1.0 2.34(1.26-4.36)* 2.15(1.04-4.46)* 1.67(0.81-3.42) CAT
C/C 203 153 122 145
C/T+T/T 13 14 12 18
OR(95%CI) 1.0 1.43(0.65-3.13) 1.54(0.68-3.47) 1.94(0.92-4.08) OR(95%CI)c 1.0 1.40(0.57-3.41) 1.34(0.50-3.63) 1.60(0.64-4.04) GPx1
Pro/Pro 193 146 123 145
Pro/Leu 19 17 9 15
OR(95%CI) 1.0 1.18(0.59-2.36) 0.74(0.33-1.70) 1.05(0.52-2.14) OR(95%CI)c 1.0 1.43(0.62-3.29) 1.00(0.36-2.77) 1.34(0.56-3.23)
a 對照組為 0；一條冠狀動脈阻塞超過 50%為 1；二條冠狀動脈阻塞超過 50%為 2；三條冠狀
動脈阻塞超過 50%為 3
b Val/Ala + Ala/Ala
c 調整年齡、性別、吸菸習慣、飲酒習慣、膽固醇、HDL
* p < 0.05
表十三 氧化壓力基因多形性與冠狀動脈心臟病之相關性依年齡分組
＜60 ≧60
基因型 cases/controls OR(95%CI) a cases/controls OR(95%CI) a p-valuec
MnSOD 0.98
Pro/Leu 15/12 1.38(0.53-3.63) 26/7 1.17(0.42-3.27)
a 調整性別、抽菸習慣、喝酒習慣、膽固醇、HDL
b Val/Ala + Ala/Ala
c Interaction p-value
表十四 氧化壓力基因多形性與冠狀動脈心臟病之相關性依性別分組
男性 女性
基因型 cases/controls OR(95%CI) a cases/controls OR(95%CI) a p-valuec
MnSOD 0.93
Pro/Leu 30/9 1.36(0.54-3.44) 13/10 1.38(0.42-4.57)
a 調整年齡、抽菸習慣、喝酒習慣、膽固醇、HDL
b Ala/Val+Ala/Ala
c Interaction p-value
* p < 0.05
表十五 氧化壓力基因型交互作用與冠狀動脈心臟病之勝算比
表十五 氧化壓力基因型交互作用與冠狀動脈心臟病之勝算比