青年初发急性心肌梗死患者心肌梗死类型及危险因素变化趋势分析  

Trends and Subtypes of Acute Myocardial Infarction and Modifiable Risk Factors in Chinese Young Adults Hospitalized With First Acute Myocardial Infarction

作　　者：左惠娟 杨红霞 南楠 张东凤 王锦纹 宋现涛 ZUO Huijuan;YANG Hongxia;NAN Nan;ZHANG Dongfeng;WANG Jinwen;SONG Xiantao(Department of Community Health Research,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lunga nd Blood Vessel Diseases,Beijing(100029),China)

机构地区：[1]首都医科大学附属北京安贞医院人群防治研究室,北京市100029

出　　处：《中国循环杂志》2021年第4期329-334,共6页Chinese Circulation Journal

基　　金：心血管疾病精准医学北京实验室基金项目(PXM2018_014226_000013)。

摘　　要：目的:分析青年(18~44岁)初发急性心肌梗死(AMI)患者心肌梗死类型及危险因素变化趋势。方法:收集2007年1月至2017年12月我院18~44岁初次诊断为AMI的住院患者。通过电子病历系统提取患者年龄、性别、出院诊断等一般临床资料,高血压病史、糖尿病病史、高胆固醇血症、肥胖、吸烟和饮酒6项心血管疾病可改变危险因素相关信息以及冠状动脉造影结果。结果:共纳入青年初发AMI患者2866例,男性2739例(95.6%),年龄(38.9±4.7)岁。心血管疾病可改变的危险因素前三位分别是吸烟[2084例(72.7%)]、高血压[1170例(40.8%)]和肥胖[1084例(37.8%)]。心肌梗死类型以ST段抬高型心肌梗死(STEMI)为主(77.3%)。非ST段抬高型心肌梗死(NSTEMI)构成比呈现上升趋势,由2007年的9.2%上升到2017年的36.9%,上升了27.7%(P_(趋势)<0.001)。NSTEMI患者中高血压、糖尿病、高胆固醇血症和肥胖者比例显著高于STEMI患者,单支冠状动脉病变者比例低于STEMI患者(P均<0.05);随着代谢危险因素(高血压、糖尿病、高胆固醇血症和肥胖)数目增多,临床表现为NSTEMI的几率增加(OR=1.39,95%CI:1.20~1.60,P<0.001);与单支冠状动脉病变患者相比,多支冠状动脉病变患者(OR=1.27,95%CI:1.05~1.54,P<0.05)以及冠状动脉正常或无明显狭窄患者(OR=2.15,95%CI:1.59~2.90,P<0.001)临床表现为NSTEMI的几率增加。2007~2017年,多个(2个以上)代谢危险因素者比例显著上升(P_(趋势)=0.01),单支冠状动脉病变者比例显著下降(P_(趋势)=0.001)。结论:青年初发AMI患者以男性占绝对优势,心肌梗死类型仍以STEMI为主,但NSTEMI构成比呈上升趋势,多个代谢危险因素及冠状动脉病变特点变化与NSTEMI构成比趋势变化有关。Objectives:This study aimed to estimate the temporal trends and subtype of acute myocardial infarction(AMI)and association with modifiable risk factors of cardiovascular disease in Chinese young adults hospitalized with first AMI.Methods:This was a retrospective cohort analysis based on medical records from Beijing Anzhen hospital from January 2007 to December 2017.Hospitalized young adults(18 to 44 years)for first AMI were identified.Demographic and clinical data(gender,age and discharge diagnosis),modifiable cardiovascular risk factors(hypertension,diabetes,hypercholesterolemia,obesity,smoking and drinking)were analyzed,and coronary angiography findings were reviewed by experienced cardiologists.Results:This study included 2866 young adults with first AMI(male,n=2739,female,n=127),the mean age was(38.9±4.7)years.Smoking(2084[72.7%]),hypertension(1170[40.8%])and obesity(1084[37.8%])were most prevalent.Presentation of AMI was more frequently ST-segment elevation myocardial infarction(STEMI,77.3%,2214/2866).Non-ST segment elevated myocardial infarction(NSTEMI)showed an increasing trend,proportion of NSTEMI increased from 9.2%to 36.9%between 2007 and 2017(rate difference 27.7%,P_(trend)<0.001).NSTEMI patients had a higher prevalence of hypertension,diabetes,hypercholesterolemia and obesity,and lower prevalence of coronary single vessel disease as compared to STEMI patients(all P<0.05).Logistic regression analysis showed that multiple metabolic risk factors significantly increased the risk of NSTEMI(OR=1.39,95%CI:1.20-1.60),patients with multi-vessel coronary disease(OR=1.27,95%CI:1.05-1.54)and patients without significant coronary stenosis or normal patients(OR=2.15,95%CI:1.59-2.90)faced much higher risk of NSTEMI compared with those with coronary single vessel disease.The prevalence of multiple metabolic risk factors increased and coronary single vessel disease decreased significantly from 2007 to 2017(all P_(trend)<0.05).Conclusions:Proportion of young adults with first AMI is significantly higher in males than

关 键 词：心血管疾病 急性心肌梗死 危险因素 青年 

分 类 号：R54[医药卫生—心血管疾病]