25岁以下年轻人初发急性心肌梗死的临床特点及长期预后分析  

Clinical characteristics and long-term prognosis of patients agedunder 25 years with acute myocardial infarction

作　　者：余航 李淼静 刘芳[2] 王洁[1,2] YU Hang;LI Miaojing;LIU Fang;WANG Jie(Department of Cardiovascular Medicine,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Hematology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西西安710061 [2]西安交通大学第一附属医院血液内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2024年第4期609-615,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省重点研发计划项目(No.2022SF-239)。

摘　　要：目的 探讨25岁以下年轻人初发急性心肌梗死(AMI)的临床特征及长期预后分析。方法 对2013年2月至2023年7月就诊西安交通大学第一附属医院的25岁以下年轻人初发AMI患者(年轻组)的临床资料进行分析,同时选取同时间段就诊的年龄25~44岁性别相同且发病部位相同的中青年AMI患者(中青年组)作为对照组(1∶2入组),比较两组患者的合并症、高危因素及生化指标等临床特征及预后。结果 共纳入84例患者,其中年轻组28例,中青年组56例。年轻组患者中以单支病变(15/26,57.7%)或未见明显罪犯血管(7/26,26.9%)为主,白细胞计数及尿酸水平明显高于中青年组。中位随访时间72.4(25.5,110.2)个月。Cox回归模型分析,年轻组(HR=7.925,95%CI:1.861~33.749,P=0.005)、住院时长(HR=1.183,95%CI:1.001~1.398,P=0.048)及合并典型心绞痛症状(HR=0.090,95%CI:0.015~0.544,P=0.009)是影响总生存期的独立影响因素。结论 相对于中青年AMI患者,年轻组AMI患者预后更差。年轻AMI患者(25岁以下)、住院时长及合并不典型心绞痛症状是影响该人群AMI患者的主要危险因素。因此,早期发现及识别年轻患者发生AMI有助于改善患者预后。Objective To investigate the clinical characteristics and long-term prognosis of patients aged under 25 years with acute myocardial infarction(AMI).Methods We enrolled the patients aged under 25 years(young group)who were diagnosed with AMI at The First Affiliated Hospital of Xi’an Jiaotong University from February 2013 to July 2023.And the patients who were admitted to the hospital during the same period and aged 25-44 years with the same gender and the same infarct sites were selected as the control group(young and middle-aged group)(1∶2).The clinical data of the two groups including comorbidities,high risk factors and biochemical indicators were collected and compared,and prognostic factors were analyzed.Results In this study,we enrolled a total of 84 AMI patients:28 in the young group and 56 in the young and middle-aged group.The patients in young group had single-vessel disease(15/26,57.7%)and no obvious culprit vessel(7/26,26.9%);their white blood cell count and uric acid level were significantly higher than those of the young and middle-aged group.The median follow-up was 72.4(25.5,110.2)months in this study.The results of univariate and multivariate Cox proportional hazards regression model analysis showed that the younger group(HR=7.925,95%CI:1.861-33.749,P=0.005),length of hospital stay(HR=1.183,95%CI:1.001-1.398,P=0.048),and complicated typical angina symptoms(HR=0.090,95%CI:0.015-0.544,P=0.009)were independent factors affecting the patients’overall surivival.Conclusion Compared to middle-aged and young AMI patients,the younger AMI ones have a worse prognosis.Young patients(under 25 years),length of hospital stay and atypical angina symptoms are the most important risk factors for patients with AMI.Therefore,early detection and identification of AMI in young patients is helpful for improving the patients’prognosis.

关 键 词：年轻人 中青年 急性心肌梗死(AMI) 临床特征 预后分析 

分 类 号：R541.4[医药卫生—心血管疾病]