老年人急性心肌梗死合并梗死区微血管阻塞的临床研究

Clinical features of acute myocardial infarction in old patients with microvascular obstruction

目的 探讨老年人急性心肌梗死 (AMI)合并梗死区微血管阻塞 (MO)时的临床特点及意义。方法 对 1 9例老年AMI患者及 2 5例非老年AMI患者的心电图、心肌酶学和磁共振成像等资料进行比较分析。结果 ①≥ 70岁组合并MO的比例 (2 4,50 % )高于 <60岁组 (6 2 5 ,2 4 % ;P =0 .30 )。②≥ 60岁组合并MO的患者共有5例 ,血清肌酸激酶 (CK)峰值为 (778.4± 2 69.8)U L ,明显低于合并MO的 <60岁组 6例为 (1 92 4 .2± 1 0 94.2 )U L ,差异有显著性意义 (P =0 .0 4 9)。③≥ 60岁组合并MO的心肌梗死面积为 2 8.3 %± 5 .9% ,低于 <60岁组的36 .1 %± 1 1 .0 % (P =0 .1 88) ,但高于≥ 60岁不合并MO的患者的 2 3 .8%± 1 0 .5 % (P =0 .387)。结论 高龄老年人AMI合并MO的可能性较大 ,老年患者合并MO时 ,虽然梗死面积明显增大 。

Objective To investigate the clinical features of acute myocardial infarction (AMI) in old patients with microvascular obstruction (MO). Methods The electrocardiography, myocardial enzyme and magnetic resonance imaging data of 44 AMI patients were analyzed retrospectively. Results ① Compared with AMI patients who were <60 years of age(6/25, 24%), the patients who were ≥70 years old had a higher incidence of MO (2/4, 50%; P=0.30). ② The average CK peak of old AMI patients (≥60 years old ) with MO was (778.4±269.8)U/L, which was significantly lower than that of younger patients (<60 years old) with MO (1 924.2±1 094.2) U/L( P=0.049). ③ The average infarct myocardial size of old AMI patients (≥60 years old ) with MO 28.3%±5.9% was smaller than that of younger patients ( <60 years old) with MO (36.1%±11.0%, P=0.188), but was larger than old patients(≥60 years old) without MO ( 23.8% ±10.5%, P=0.387). Conclusion The elder AMI patients may have a higher incidence of MO. The lower cardiac enzyme peaks and larger infarct size may be present in the old AMI patients with MO.