青年急性心肌梗死患者危险因素和促发因素的临床分析

Clinical analysis of the risk factors and inducing factors of the AMI of younger adults

目的:结合新近发现的冠心病危险因素,总结青年人急性心肌梗死(AMI)的临床特点,并探讨其早发心肌梗死的可能机制。方法:回顾性对照分析青年组(≤40岁)和非青年组(≥50岁)AMI患者的危险因素和促发因素的分布及聚集状况,并行冠状动脉造影检查。结果:2组患者危险因素分布存在差异,青年组吸烟及家族史阳性率明显高于非青年组,新的危险因素中,青年组同型半胱氨酸(HCY)明显低于非青年组(P<0.05);青年组危险因素聚集率并不比非青年组高,但其发生AMI前多有明确的促发因素,且促发因素有聚集倾向。结论:青年人早发AMI可能与促发因素聚集有关,多种促发因素同时存在通过心肌缺血叠加效应导致动脉粥样硬化(AS)患者和非AS患者发生AMI。

Objective：To summarize the clinical characters of acute myocardial infarction （AMI） of the younger adults and explore the possible mechanisms of early myocardial infarction related to the newly discovered risk factors of coronary heart disease. Method： We reviewed the clustering status and the frequencies of risk factors and inducing factors of two groups of AMI patients： younger adults group （≤40 years old） and aged adults group （≥50 years old）. Coronary angiograghy was performed in these patients. Result：There were differentiations of frequencies of risk factors between these two groups. The smoking rate and positive family history rate of the younger adults group were markedly higher than those of aged adults group （ P〈0.05）. Among the new risk factors, homocysteine of the younger adults group was strikingly lower than that of aged adults group （ P〈0.05）. Although the clustering status of risk factors of the younger adults group was not higher than that of aged adults group, there were obvious inducing factors before they were attacked by AMI and the inducing factors inclined to cluster. Conclusion：Early AMI of younger adults might relate to the clustering status of inducing factors. The coexist of several kinds of inducing factors result in the occurrence of AMI in atherosclerosis （AS） and none AS patients by means of myocardial ischemia accumulation effect.