40岁以下初发急性心肌梗死的吸烟男性冠状动脉病变特点  

Coronary characteristics of ≤40 years male smokers with first acute myocardial infarction

作　　者：朱定君[1] 石蓓[2] 夏鸿莉[3] 张凯[1] 吴勇波[1] 刘紫燕[1] 金道群[1] 李振龙[1] 赵琳[1] 蔡丽芹[1] 陈志强[1] 

机构地区：[1]黄石市中心医院(湖北理工学院附属医院)心内科,湖北省435000 [2]遵义医学院附属医院心内科 [3]黄石市中心医院(湖北理工学院附属医院)急诊科,湖北省435000

出　　处：《中华临床医师杂志（电子版）》2013年第4期84-87,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察吸烟对40岁以下初发急性心肌梗死(AMI)的男性患者冠状动脉病变的影响。方法入选确诊首发急性心肌梗死的40岁以下男性260例,根据吸烟情况分为吸烟组(n=192)和不吸烟组(n=68),皆排除合并有高血压、高胆固醇及糖尿病等冠心病主要危险因素病例。通过冠状动脉造影分析患者的冠状动脉病变特点。结果两组平均年龄相近,均以单支病变为主,三支病变较少。吸烟组单支病变比例低于不吸烟组(50.5%vs.75.0%,P<0.001),而双支病变比例高于不吸烟组(29.2%vs.14.7%,P<0.05)。吸烟组0支病变和三支病变比例高于不吸烟组(13.0%vs.7.4%,7.3%vs.2.9%),但无统计学意义(P>0.05)。单支病变亚组中,两组均以左前降支病变为主,右冠状动脉次之,回旋支较少。吸烟组右冠状动脉病变比例高于不吸烟组(21.4%vs.10.3%,P<0.05),不吸烟组左前降支病变明显高于吸烟组(61.0%vs.24.5%,P<0.001)。双支病变亚组中,包含右冠状动脉病变组合(右冠状动脉+左前降支及右冠状动脉+回旋支)比例吸烟患者多见,和不吸烟组比较,均有统计学意义(P<0.05)。另外,吸烟组冠状动脉瘤样扩张比例明显高于不吸烟组(12.5%vs.2.9%,P<0.05),且吸烟者大多数发生于右冠状动脉(共20例占83%)。吸烟组Gensini积分亦高于不吸烟组(49.5±33.9vs.39.3±26.4,P<0.05)。结论不合并其他危险因素的吸烟青年男性AMI患者病变程度重于不合并其他危险因素非吸烟AMI患者;与不吸烟患者比较,其右冠状动脉狭窄病变及冠状动脉瘤样扩张病变尤其右冠状动脉动脉瘤样扩张病变均多见。Objective To investigate the effect of smoking on coronary characteristics of ≤40 years male smokers with first acute myocardial infarction（AMI）. Methods A total of 260 men（ ≤40 years）diagnosed with first AMI were included in this study, they were divided into smokers group （n = 192 ） and nonsmokers group （n = 68 ） according to smoking status, all those patients with either hypertension, hypercholesterolemia or diabetes were excluded. Coronary angiography was performed in all of them before hospital discharge and coronary lesions were assessed. Results Two groups had a similar age, and were more likely to have single-vessel disease and less likely to have triple-vessel disease. The percentage of patients with single-vessel disease was lower in smokers than nonsmokers （50. 5% vs. 75.0% ,P 〈 0. 001 ）, whereas, the percentage double-vessel disease was higher in smokers than non- smokers （29. 2% vs. 14. 7% ,P 〈 0. 05 ）. Also, incidence of zero-vessel disease and triple-vessel disease was higher in smokers than nonsmokers（ 13.0% vs. 7.4% ,7.3% vs. 2. 9% ,respectively） ,but there were no significant differences （ both P 〉 0.05 ）. Among the patients with single-vessel disease, coronary obstruction was most frequently found in the left anterior descending artery, followed by the fight and circumflex arteries. A higher percentage of smoking patients,however,had right coronary disease than nonsmokers （21.4% vs. 10. 3% ,P 〈0. 05）. In contrast,smokers had less frequent obstruction in anterior descending artery than nonsmokers （ 61.0% vs. 24. 5%, P 〈 0. 001 ）. Similarly among patterns of double-vessel disease ,the two distributions including the right coronary artery were more prevalent in smokers than in nonsmokers. Both differences were significantly different （ P 〈 0. 05 ）. In addition,coronary artery ectasias were more popular in smokers compared with non-smokers. Especially, ectasia most frequently affected the right coronary artery （20 patients） among smoke

关 键 词：心肌梗死 冠状动脉疾病 吸烟 男(雄)性 

分 类 号：R542.22[医药卫生—心血管疾病]