女性ST段抬高型心肌梗死患者临床特征和预后影响因素分析  

Clinical characteristics and influencing factors of prognosis in female patients with ST-segment elevation myocardial infarction

作　　者：王丽[1] 韩桢[1] 刘昶[1] 满秀荣 王国兴[1] WANG Li;HAN Zhen;LIU Chang;MAN Xiu-rong;WANG Guo-xing(Depurtment of Emergency,Beijing Friendship Hospital.Capital Medical University,Beijing 100050,China;Department of Cardiology,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050 [2]清华大学第一附属医院心内科,北京100016

出　　处：《中华实用诊断与治疗杂志》2021年第7期653-657,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81773931)。

摘　　要：目的观察女性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者临床特征,探讨影响其预后的因素。方法 STEMI患者285例,58例女性为女性组,227例男性为男性组。比较2组年龄、基础疾病(糖尿病、高血压、高脂血症)、吸烟、Killip分级;记录发病至入住CCU时间,入院时收缩压,入院24 h内白细胞计数、血小板计数、肌酸激酶同工酶峰值、C反应蛋白、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)等实验室指标水平,以及左室射血分数、左心室舒张末期内径;比较2组梗死相关血管及病变血管支数;比较2组接受急诊/择期经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)或经皮冠状动脉球囊血管成形术(percutaneous transluminal coronary angioplasty, PTCA)、入院24 h内应用β受体阻滞剂及血管紧张素转换酶抑制剂比率;比较2组住院期间主要心血管不良事件(major adverse cardiovascular, MACE)发生率。随访52个月,比较2组MACE发生率及心血管死亡累积发生率;多因素Cox回归分析女性STEMI患者发生MACE的影响因素。结果女性组吸烟比率(19.0%)低于男性组(69.6%)(P<0.05),年龄[(70.16±9.05)岁]大于男性组[(57.71±11.68)岁](P<0.05),糖尿病(32.8%)、高血压(65.5%)、Killip分级≥Ⅱ级(46.6%)比率及入院24 h内血糖[7.64(5.70,12.39)mmol/L]、NT-proBNP[109.00(60.45,192.50)pg/L]水平均高于男性组[19.4%、45.4%、28.2%、6.41(4.87,8.36)mmol/L、58.70(21.80,116.78)pg/L](P<0.05),高脂血症比率、发病至入住CCU时间、入院时收缩压及入院24 h内白细胞计数、血小板计数、低密度脂蛋白胆固醇、三酰甘油、血肌酐、血尿酸、同型半胱氨酸、肌酸激酶同工酶峰值、C反应蛋白水平及左室射血分数、左心室舒张末期内径与男性组比较差异均无统计学意义(P>0.05)。女性组梗死相关血管及病变血管支数与男性组比较差异均无统计学意义(P>0.05)。女Objective To observe the clinical characteristics of ST-segment elevation myocardial infarction(STEMI)in female patients,and to analyze the influencing factors of the prognosis.Methods Totally 285 patients with STEMI were divided into female group(n=58)and male group(n=227).The age,diabetes,hypertension,hyperlipidemia,smoking history and Killip grade were compared between two groups.The time from onset to entering CCU,systolic blood pressure at admission,and the white blood cell count,platelet count,peak creatine kinase isoenzyme,C-reactive protein and N-terminal pro-brain natriuretic peptide(NT-proBNP)24 h after admission,as well as the left ventricular ejection fraction and left ventricular end-diastolic dimension were recorded.The numbers of infarct-related artery and diseased vessels,the percentages of patients receiving primary/selected percutaneous coronary intervention or percutaneous transluminal coronary angioplasty,the percentages of patients receiving beta-receptor blockers and ACE inhibitors 24 h after admission,the incidence of major adverse cardiovascular events(MACE)and the mortality were compared between two groups.The patients were followed up for 52 months,and the incidence of MACE and the cumulative cardiovascular mortality were compared between two groups.Multivariate Cox regression analysis was used to assess the influencing factors of MACE in female patients with STEMI.Results The percentage of patients with smoking history was lower in female group(19.0%)than that in male group(69.6%)(P<0.05),the patients were older in female group((70.16±9.05)years)than in male group((57.71±11.68)years)(P<0.05),the percentages of diabetes(32.8%),hypertension(65.5%)and Killip grade≥Ⅱ(46.6%)as well as the levels of fasting plasma glucose(7.64(5.70,12.39)mmol/L)and NT-proBNP(109.00(60.45,192.50)pg/L)in female group were higher than those in male group(19.4%,45.4%,28.2%,6.41(4.87,8.36)mmol/L,58.70(21.80,116.78)pg/L)(P<0.05),and there were no significant differences in the percentage of hyperlipidemia,tim

关 键 词：ST段抬高型心肌梗死 女性 主要心血管不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]