摘要
目的:探讨分析单中心10年来40岁以下急性心肌梗死(AMI)患者的危险因素及冠脉造影特点。方法:收集分析1999年1月至2009年1月入住本院诊断为急性心肌梗死的青年(<40岁)患者的临床特征及冠脉造影等资料,同时收集老年(60～75岁)患者进行配对比较。结果:青年组106例,老年组112例,青年组中91.5%为ST段抬高型心肌梗死。与老年组相比,青年组绝大多数为男性,有吸烟史、饮酒史、冠心病家族史者比例和血甘油三酯(TG)水平显著升高,而高血压病史、糖尿病史比例、脉压差、空腹血糖显著降低。青年组行冠脉造影的比例高(64.2%vs.40.2%,P<0.05),其冠脉病变以单支病变为主(58.82%vs.13.33%,P<0.05),前降支最易受累(56.63%vs.32.29%,P<0.01),左主干未见受累(0vs.10.42%,P<0.01),Genisini积分低(23.69±22.80vs.39.21±40.37,P<0.05)。多元线性回归分析显示青年患者的高血压史、脂蛋白(a)[Lp(a)]和吸烟指数是冠状动脉Gensini积分的独立影响因子。结论:吸烟、饮酒、家族史、高TG是40岁以下AMI的主要危险因素;青年患者冠脉病变程度低于老年组,需加强健康教育,控制血压,积极戒烟等改善生活方式以减少青年心肌梗死发生。
Objective：To investigate the risk factors,clinical characteristics and coronary angiographic features in patients younger than 40 years with acute myocardial infarction （AMI）.Methods：We collected data of patients with AMI from January 1999 to Jan uary 2009.Baseline clinical characteristics and coronary anatomy were compared between young （≤40 y） and older patients（60～75 y）.Results：There were 106 cases in the young group and 112 cases in the older group.ST segment elevated myocardial infarction （STEMI） was presented in 91.5% patients of the young group,who were predominantly male,more likely to smoke,drinking,have higher coronary heart disease family history positive rate,and higher triglyceride（TG） levels,compared to older patients.Also,patients in the young group had less hypertension history and diabetic history,had lower pulse pressure and fasting blood glucose.The young group had higher rates of coronary angiography （64.2% vs.40.2%,P 0.05）.Young patients were more likely to have single-vessel disease （58.82% vs.13.33%,P 0.05）.Analysis of coronary angiogram also showed that the left anterior descending artery was the most commonly involved infarct related artery（56.63% vs.32.29%,P 0.01）,no left main artery was involved in young group（0 vs.10.42%,P 0.01）.Genisini scores were lower in young patients compared to the older group （23.69±22.80 vs.39.21±40.37,P 0.05）.Multiple linear regression analysis showed that history of hypertension,Lp（a） and smoking index were independent influent factors for genisini scores in young patients with AMI.Conclusion：Smoking,drinking,family history and high TG were major risk factors for AMI in young who had less coronary pathological change,but strengthen the health education and improve the lifestyle such as hypertension control and smoking cessation should be strengthen to reduce the incidence of AMI in youngs.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2010年第11期1618-1622,共5页
Journal of Nanjing Medical University(Natural Sciences)
基金
国家“十一五”科技支撑计划项目(2007BAI07A10)
山西省自然科学基金(20021111)
江苏省普通高校研究生科研创新计划资助项目
关键词
急性心肌梗死
青年
危险因素
冠状动脉造影
acute myocardial infarction
young patients
risk factors
coronary angiography
