80岁及以上老年冠心病患者临床病理特点分析

Pathological characteristics of coronary artery disease in elderly patients aged 80 years and over

目的总结≥80岁老年冠心病患者的心脏病理特点，分析临床诊断和病理诊断的差异。 方法 回顾性分析1969年4月1日至2013年10月31日北京医院病理科资料库的系统病理解剖资料，纳入60～100岁老年尸体解剖病例，共909例，分为60～79岁组（456例）和≥80岁组（453例）。通过与60～79岁组比较，总结≥80岁组中病理诊断冠心病的检出率，分析病理诊断冠心病病例中急性心肌梗死、陈旧性心肌梗死、慢性心肌缺血的比例，以病理诊断为金标准，评价临床诊断冠心病的误诊率和漏诊率。 结果 与60～79岁组比较，≥80岁组中冠心病病理检出率更高[63.8%（289/453）比39.9%（182/456），P〈0.01]。与60～79岁冠心病（病理诊断）病例比较，≥80岁冠心病（病理诊断）病例中陈旧性心肌梗死[63.0%（182/289）比51.6%（94/182），P〈0.05]和慢性心肌缺血[22.5%（65/289）比7.1%（13/182），P〈0.01]检出率更高，而急性心肌梗死的检出率较低[22.1%（64/289）比42.9%（78/182），P〈0.01]。以病理诊断为金标准评价临床诊断水平，≥80岁老年患者中冠心病临床误诊率为65.2%（107/164），陈旧性心肌梗死和急性心肌梗死的临床漏诊率为62.1%（113/182）和37.5%（24/64）。结论 在≥80岁老年住院死亡患者中冠心病比例较高，且临床易误诊。陈旧性心肌梗死在≥80岁冠心病患者中多见，且临床易漏诊。对≥80岁住院患者应加强冠心病的诊治和评估。

ObjectiveTo define the pathological changes of coronary artery and compare the clinical diagnosis and pathological diagnosis differences in elderly patients aged 80 and over. MethodsA total of 909 autopsy cases aged 60-100 years in our hospital from April 1st 1969 to October 31th 2013 were analyzed. The prevalence and pathological features of coronary artery disease （CAD） in cases aged 80 years and over were compared with those aged 60-79 years old. The misdiagnosis and missed diagnosis rate were calculated. ResultsThe prevalence of CAD by autopsy （63.8% （289/453） vs. 39.9% （182/456）, P〈0.01）, old myocardial infarction （OMI） by autopsy （63.0% （182/289） vs. 51.6% （94/182）, P〈0.05） and chronic myocardial ischemia by autopsy （22.5% （65/289） vs. 7.1% （13/182）, P〈0.01） were significantly higher while the prevalence of acute myocardial infarction （AMI） by autopsy was significantly lower （22.1% （64/289） vs. 42.9% （78/182）, P〈0.01） in aged 80 and over group compared to 60-79 years old group. The misdiagnosis rate of CAD was 65.2% （107/164）, the missed diagnosis rate of OMI was 62.1% （113/182） and the missed diagnosis rate of AMI was 37.5% （24/64） in the aged 80 and over group. ConclusionsThe prevalence of CAD and misdiagnosis and missed diagnosis rate are high in dead inpatients aged 80 years and over. OMI is more common but often missed in this group. Thus, the diagnosis and evaluation of CAD should be enhanced in this patient group.