青年男性急性ST段抬高型心梗的危险因素和冠脉病变特点  

Risk factors and clinical characteristics of acute ST segment elevation myocardial infarction among young men

作　　者：董征[1] 王国宏[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管疾病诊疗中心,北京100176

出　　处：《中国急救复苏与灾害医学杂志》2017年第10期948-951,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的分析青年男性急性sT段抬高型心梗（ST segment elevation myocardial infarction, STEMI）的危险因素和冠状动脉病变特点。方法选取首都医科大学附属北京同仁医院住院诊断STEMI并直接行经皮腔内冠状动脉成形术 （percutaneous transluminal coronary angioplasty, PTCA）的青年男性患者为病例组，共91例，选取同期住院并行冠脉造影检查排除冠心病的青年男性（63例）、同期住院诊断STEMI并直接PTCA的中年男性（79例）、老年男性（66例）为对照组。分析4组研究对象的临床资料、青年男性STEMI危险因素及STEMI组冠状动脉造影特点。结果青年男性STEMI组，与青年男性对照组相比，超重、吸烟、2型糖尿病比例高，空腹血糖高（均P〈0．05）；与中年男性STEMI组相比，早发冠心病家族史比例低．总胆固醇、血红蛋白高，尿素氮低（均P〈0．05）；与老年STEMI组相比，血红蛋白、舒张压、总胆固醇、甘油三酯、体重指数高，糖化血红蛋白、尿素氮低，正常体重比例低（均P〈0．05）。与青年男性STEM]相关的危险因素依次是吸烟（OR=4．506）、糖化血红蛋白（OR=1．697）、舒张压（OR=1．041），空腹血糖（OR=O．296）（均P〈0．05）。青年男性STEMI组与中年、老年STEMI组比较，梗死相关血管好发于前降支，其次为右冠和回旋支，但三组间差异无统计学意义。其中，青年男性STEMI组以单支血管病变为主，45例（49．45％）；中老年男性STEMI组以三支血管病变为主（P〈0．05）。结论急性心梗趋于年轻化，青年男性STEMI的危险因素和冠状动脉病变特点与中老年人不同，应该有针对性的预防和治疗。Objective To investigate the risk factors and clinical characteristicsof actue ST-segment elevation myocardial infarction （STEM[） among young men. Methods The medical data of 299 males, including 91 STEMI patients aged 18-44 undergoing percutaneous transluminal coronary angioplasty （PTCA） （young men with STEMI group）, 63 young men of the same age who underwent PTCA to exclude the diagnosis of coronary heart disease （CAD） （young men without CAD control group）, 79 STEMI patients aged 45 - 60 （middle-aged men with STEMI group）, and 66 o]d STEMI patients aged 〉60 （elderly men with STEMI group）. Results 1. In comparison with the young men without CAD control group, the proportions of overweight, smoking, and type 2 diabetes mellitus, and fasting blood glucose level of the young men with STEMI group were all significantly higher than those of the young men without CAD group （all P〈0.05）. Compared with the middle-aged men with STEMI group, the proportion of family history of premature CAD and urea nitrogen level of the young men with STEMI group were both significantly lower, and the levels of total cholesterol and hemoglobin were both significantly higher （all P〈0.05）. Compared with the old men with STEMI group, the proportion of normal weight, and the levels of glycosylated hemoglobin and blood urea nitrogen of the young men with STEMI group was all significantly lower; and the levels of hemoglobin, diastolic blood pressure, total cholesterol, triglyceride, and body mass index were all significantly higher （all P〈0.05）. 2. Smoking （OR 4.506）, glycosylated hemoglobin （OR 1.697）, diastolic pressure （OR 1.041）, and fasting blood glucose （OR 0.296） were all independent risk factors （all P〈0.05） for young men with STEMI. 3. In the young men with STEMI, the infarction related artery was oftren found to be the anterior descending artery, followed by right coronary artery and circumflex branch, but there were no significant differences among these three gro

关 键 词：急性心梗 青年男性 危险因素 冠状动脉造影 

分 类 号：R4[医药卫生—临床医学]