心肌梗死后死亡率的性别差异前瞻性研究

Survival time after myocardial infarction in man and woman: prospective observational study

目的:比较心肌梗死(MI)患者的特征、处置与病死率在性别方面的差异。方法:收集1998～2004年在贵阳医学院附属医院住院的首次MI患者856例男性和587例女性资料并随访至2005年6月,分析比较MI患者的临床特征、处置与病死率在性别方面的差异。结果:在随访期有351例(41.00%)男性和283例(48.21%)女性死亡。单因素分析显示女性有较高的病死率(风险率1.44,95%CI为1.24～1.67,P<0.01),但经过年龄、吸烟、伴存疾病、心血管病病史、糖尿病、高血压和情感抑郁等多因素调整后无差异(风险率1.01,95%CI为0.87～1.19,P>0.05)。MI后1个月内女性有较高的病死率(风险率1.53,95%CI为1.19～1.96,P<0.01),但经过上述多因素调整后无差异(风险率1.03,95%CI为0.78～1.36,P>0.05)。分析用药的情况发现女性使用他汀类药物比例高(调整后OR=1.47,95%CI为1.09～1.96,P<0.01),而β受体阻滞剂较少(调整后OR=0.77,95%CI为0.59～1.00,P<0.05)。其他2级预防药物及溶栓药物无差异。结论:男、女性在MI预后差别的主要原因在于患者的年龄、处置和多因素的影响,如果女性患者能得到相同的处置,则生存率将与男性相同。

Objective：To compare characteristics, management, and outcome of myocardial infarction （MI） in man and woman. Method：To collect data from 856 men and 587 women with first MI between 1998 and 2004 and follow up to the end of 2005. To compare and analyse characteristics, management, and outcome of myocardial infarction （MI） in man and woman. Result：The 351（41.00%）men and 283（48.21%） women died during a median follow up of 3.4 years for the survivors. Univariate analysis indicated on an excess mortality among women（hazard ratio（HR） 1.44,95 % CI 1.24-1.67, P 〈0.01）,which disappeared after adjustment for age, smoking, co-morbidity, previous vascular disease, diabetes, hypertention, and social deprivation（ HR1.01,95 % CI 0. 87 - 1.19, P〉 0. 05）. There was also an excess early mortality within 1 month among women（HR1.53,95 % CI 1.19-1.96, P〈0. 01）, this did not retain significance after adjustment for the same covariates（HR1.03,95 % CI 0. 78- 1.36, P〉0.05）. Small and insignificanct differences were found in the proportion of men and women receiving thrombolysis on admission and secondary prophylactic drugs at discharge, except for statins and β blockers, which were respectively more（adjusted OR = 1.47, 95 % CI 1.09- 1.96, P〈0. 01 ）and less（adjusted OR =0. 77, 95 % CI 0. 59 -1.00, P 〈 0. 05 ） commonly prescribed to women. Conclusion： Results suggest that the poorer outcome for women after MI reported in other studies may reflect sex bias in management as well as differences in age and comorbidity and support the view that if women have access to the same quality of care as men then survival will be the same.