性别对高龄急性冠状动脉综合征患者治疗策略的影响  

Effects of gender on treatment strategies for elderly patients with acute coronary syndrome

作　　者：崔美平[1] 张彬[1] 蒋文彬[1] 朱明真[1] 姜先雁[1] 朱凌华[1] 常瑜[1] 郭晓[1] 王松涛[1] 路长鸿[1] 葛毅萍[1] 曲风霞[1] 

机构地区：[1]山东青岛阜外心血管病医院心脏中心,266034

出　　处：《中华医学杂志》2013年第34期2739-2741,共3页National Medical Journal of China

摘　　要：目的探讨性别对高龄急性冠状动脉综合征（ACS）患者治疗策略的影响。方法选取2009年3月至2012年3月在青岛阜外心血管病医院心脏中心接受冠状动脉造影检查的高龄ACS患者619例，其中男346例，女273例。比较两组间危险因素、ACS诊断、冠状动脉造影结果、治疗方式及预后。结果危险因素方面，与男性组相比，女性的体质指数、脑卒中病史、吸烟史、血清血红蛋白、胆固醇、低密度脂蛋白胆固醇（LDL—C）、血尿酸水平均低于男性患者组（P〈0．05）。女性的糖尿病患病率明显高于男性（27．8％比18．5％，P〈0．05）。男性组既往有心肌梗死、经皮冠状动脉介入治疗（PCI）及冠状动脉旁路移植术（CABG）率明显大于女性（48．0％比39．9％，P〈0．05；30．6％比22．3％，P〈0．05；19．9％比10．3％，P〈0．01）。女性合并多种危险因素（≥3个）者百分比明显增高（41．8％比29．8％，P〈0．05）。ACS的诊断方面，女性发生不稳定性心绞痛（UAP）及非sT段抬高性心肌梗死（NSTEMI）的比率大于男性，但两者差异无统计学意义。女性组3支病变及钙化病变多于男性（36．3％比28．6％，P〈0．05）。选择治疗策略方面，保守治疗的女性多于男性，二者差异无统计学意义。PCI的女性多于男性（26．0％比14．2％，P〈0．01）。急诊PCI及择期CABG的男性比率多于女性（14．7％比6．6％，P〈0．01；19．1％比7．7％，P〈0．叭）。两组间预后差异无统计学意义。结论高龄女性ACS的治疗策略有一定的局限性，今后应该采取积极的治疗态度，改善预后。Objective To explore the effects of gender on treatment strategies for elderly patients with acute coronary syndrome （ACS）. Methods March 2009 to March 2012, consecutive 619 aged ACS patients undergoing coronary angiography （CA） were screened at our hospital. There were 273 females and 346 males. Risk factors, ACS diagnosis, CA results, treatments and prognosis were compared between female and male groups. Results The risk factors of body mass index, stroke history, smoking history, hemoglobin （Hb） , serum cholesterol （TC） , low density lipoprotein （LDL-C） and blood uric acid （UA） levels were significantly lower in female group than those in male group （ P 〈 0. 05 ）. The morbidity of diabetes in female group was obviously higher than that in male group （27.8% vs 18.5 %, P 〈 0. 05 ）. The prevalence of myocardial infarction history, percutaneous coronary intervention （PCI）and coronary artery bypass grafting（CABG） history in male group were significantly greater than that in female group （48.0% vs 39.9%, P〈0.05; 30.6% vs22.3%, P〈0.05; 19.9% vs 10.3%, P〈0.01）. The rate of combined multiple risk factors （3 or higher） increased significantly in female group （41.8% vs 29.8%, P 〈0. 05）. The incidence of unstable angina pectoris （UAP） and non-ST segment elevation myocardial infarction （NSTEMI） in female group was greater, but there was no statistical significance. The rate of 3-vessel and calcification lesions in female group was significantly elevated compared with male group （36. 26% vs 28.61%, P 〈 0. 05）. Regarding the choice of treatment strategy, conservative treatment was common in females, but there was no statistical significance between them. PCI, emergency PCI and selective CABG operation were performed more frequently in female group compared with male group （26. 0% vs 14. 2% , P〈0.01; 14. 7% vs6.6%, P〈0.01; 19. 1% vs 7.7%, P〈0.01）. The prognosis had no statistical significance between two groups. Conclusion The treatment st

关 键 词：急性冠状动脉综合征 性别 高龄 治疗 

分 类 号：R543.3[医药卫生—心血管疾病]