APT：乳糜泻患者中缺血性心脏病的危险因素

　　近日，来自瑞典的Emilsson医师描述了不同乳糜泻状况下缺血性心脏病的特点。该文发表在2013年第37卷第9期《消化药理学和治疗学》（Aliment Pharmacol Ther）杂志上。

　　研究人员从全瑞典的28个病理科收集了2006-2008年间十二指肠或空肠活检的资料用来确定乳糜泻。

　　这项研究仅采用病例进行比较，研究团队采用瑞典心脏医疗注册系统SWEDEHEART来确定缺血性心脏病，并取得了首次发作心肌梗死时的临床状况与危险因素的资料。他们对乳糜泻患者与一般人群参考者进行了比较。

　　研究团队确定了之后出现缺血性心脏病的1075名乳糜泻患者和4142名参考者。

　　研究团队发现心肌梗死的乳糜泻患者体重指数和胆固醇水平更低，与患心肌梗死的参考个体相比嗜烟的可能性更小。

　　该团队注意到乳糜泻患者血管造影时冠状动脉病变相对并不广泛，但心肌梗死的生化标志物阳性的比例没有差异。

　　Emilsson医师的团队评论道：“虽然有乳糜泻患者缺血性心脏危险增加及心血管死亡率升高的证据，但与参考者相比，乳糜泻患者患缺血性心脏病的心血管危险模式相对更为温和。”

与乳糜泻相关的拓展阅读：

• AJG:乳糜泻发病率增加
• BMC PEDIATR：乳糜泻与婴儿感染有关
• Am J Hematol：乳糜泻病人更可能患上淋巴细胞增生性疾病 更多信息请点击：有关乳糜泻更多资讯

The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease
BACKGROUND
Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.
AIM
To characterise IHD according to CD status.
METHODS
Data on duodenal or jejunal biopsies were collected in 2006-2008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.
RESULTS
We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P < 0.001) and cholesterol values (P < 0.001) and were less likely to be active smokers (OR = 0.74; 95% CI = 0.56-0.98) than reference individuals with myocardial infarction. CD patients had less extensive coronary artery disease at angiography (any stenosis: OR = 0.80; 95% CI = 0.66-0.97; three-vessel disease: OR = 0.73; 95% CI = 0.57-0.94); but there was no difference in the proportions of CD patients with positive biochemical markers of myocardial infarction (CD: 92.2% vs. reference individuals: 91.5%, P = 0.766).
CONCLUSION
Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.