不同年龄段急性冠状动脉综合征患者的危险因素、冠状动脉病变特点及预后分析  

Analysis of risk factors,feature of coronary artery and prognosis of patients with acute coronary syndrome in different age groups

作　　者：金彦彦[1] 马长生[1] 康俊萍[1] 聂绍平[1] 张崟[1] 吕强[1] 刘晓惠[1] 董建增[1] 胡荣[1] 

机构地区：[1]首都医科大学附属安贞医院心内科二病房北京市心肺血管疾病研究所首都医科大学心脏学系,北京市100029

出　　处：《中国介入心脏病学杂志》2009年第1期28-33,共6页Chinese Journal of Interventional Cardiology

基　　金：国家重点基础研究发展规划基金资助项目(973计划)(2003CB517103)

摘　　要：目的探讨不同年龄段急性冠状动脉综合征(ACS)患者的危险因素、冠状动脉病变特点及预后。方法DESIRE为单中心回顾性注册研究,纳入接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的血运重建治疗的6005例患者。本研究从中选择ACS患者4865名,分为年龄<40岁组135名、40～49岁组738名、50～59岁1329名、60～75岁2425名、>75岁238名,回顾性分析其危险因素、冠状动脉病变特点及主要不良心脑血管事件(MACCE)发生率。结果ACS患者中以男性为主(男女之比为77.1%比22.9%,P<0.05),其中女性患者比例在50～59岁组(18.3%)、60～75岁组(30.6%)、年龄>75岁组(28.6%)比<40岁组(3.05%)、40～49岁组(7.5%)明显增加。50～59岁组、60～75岁组、年龄>75岁组患者以不稳定型心绞痛为主,而年龄<40岁组以急性ST段抬高心肌梗死多见。年龄<40岁组、40～49岁组患者多与吸烟、低高密度脂蛋白胆固醇水平、冠心病家族史有关;50～59岁组、60～75岁组及年龄>75岁组患者多与高血压、糖尿病有关。此外在60～75岁组及年龄>75岁组患者中血肌酐明显升高、血红蛋白显著下降,并且与其他各组间差异有统计学意义。冠状动脉病变支数随年龄增加而增加,且除60～75岁组(2.18±0.81支)与>75岁组(2.23±0.81支)之间差异无统计学意义外,其他各组(<40岁组1.67±0.81支,40～49岁组1.86±0.84支,50～59岁组2.04±0.85支)间差异有统计学意义。年龄>75岁组更多见到开口病变(12.2%)。年龄<40岁组及年龄>75岁组的血运重建类型差异无统计学意义。不同年龄组患者血运重建成功率差异无统计学意义。但年龄>75岁组患者完全血运重建率较低(66.8%),与其他各组(<40岁组81.5%,40～49岁组81.7%,50～59岁组78.7%,60～75岁组74.3%)相比,差异均有统计学意义(P均<0.001)。年龄>75岁组患者院内MACCE为5.0%,与其他各组(<40岁组0,40～49岁组2.0%,50～59岁组1.6%,60～75岁组2.6%)相比,差异均有�Objective To analyse the risk factors, feature of coronary artery and prognosis of ACS patients in different age groups. Methods The study is a retrospective registered study including 4 865 patients from a single center. The 4 865 patieots were divide into groups by age as： age 〈 40 years （n = 135）, 40 -49 years （n =738）, 50 -59 years （n = 1 329）, 60 -75 years （n =2425）, and age 〉75 years （ n = 238 ）. We retrospectively analysed the difference in risk factors, feature of coronary artery and MACCE in the different agegroups. Results Most of the patients are male（77. 1% vs22.9%, P〈0.05）. The female proportion increased with adding age; the proportion of female was respectively 18.3% , 30. 6% , 28.6% in the 50 - 59 years group, 60 - 75 years group and the age 〉 75 years group. The major risk factors were smoking, family history of coronary artery disease, low HDL-C in age 〈 40 years group and 40 -49 years group. The percentage of smoking patients decreased along with adding age（ 80. 8% vs 69. 3% vs 60% vs 52. 5% vs 33% , P 〈0. 001 ）. In the 50 -59 years group, 60 -75 years group and age 〉75 years group the major risk factors were hypertension and diabetes. The concentration of serum creatinine （CR） increased obviously but hemoglobin （HBG） decreased in the 60- 75 years group and age 〉75 years group （CR： 1.00±0.35, 1.08±0.31, P〈0.001; HBG. 133.86±16.46, 129. 21 ±16.90, P〈0.001）. Obesity was a risk factor in all age groups and other risk factors which could be found in all age groups included high cholSsterol, high LDL-C and high triglyceride, all these factors increased in serum concentration with adding age. Unstable angina was more after in 50 -59 years group, 60 -75 years group and age 〉 75 years group （75.3% , 78. 6% and 76. 1% respectively） , but AMI was more common in the in age 〈40 years group （42. 2% ）. The number of stenosis vessels （stenosis ≥50% ） increased with adding age. There are more ostial lesions （12. 2%, P 〈0

关 键 词：冠状动脉疾病 危险因素 预后 

分 类 号：R541.4[医药卫生—心血管疾病] R543.3[医药卫生—内科学]