年青女性冠心病危险因素和临床特点分析

Analysis of Clinical Characteristics and Risk Factors in Premanopausal Women with Coronary Heart Disease

目的:探讨绝经前年青女性冠心病患者的临床特点和危险因素。方法:选择2003-01/2007-01疑诊为冠心病而住院的绝经前女性患者86例,根据冠状动脉造影结果分为冠心病组和正常对照组,回顾性分析冠心病组的冠状动脉病变特点、临床特点及危险因素。结果:冠心病组40例,平均年龄(42.6±5.8)岁;对照组46例,平均年龄(43.8±4.6)岁。合并高血压、糖尿病、高脂血症的比例分别为67.5%vs 13.0%、50.0%vs 8.7%、55.0%vs 13.0%,两组比较差异有统计学意义(P<0.05)。总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和脂蛋白a[Lp(a)],两组比较差异有统计学意义(P<0.05),而其他女性冠心病危险因素如冠心病家族史、吸烟无统计学意义(P>0.05)。TC、LDL-C、Lp(a)在单支病变及多支病变两个亚组中,有统计学意义(P<0.05)。冠心病组典型心绞痛多见(30/40例,75.0%vs 4/46例,8.7%)(P<0.05),特异性心电图变化均高于对照组(34/40例,85.0%vs 15/46例,32.6%)(P<0.05)。ST-T改变多见于冠心病组(26/34例76.5%vs 3/15例20%)(P<0.05),单独T波改变多见于对照组(8/34例,23.5%vs 12/15例,80%)(P<0.05)。冠脉病变以单支局限性狭窄多见,占80%,前降支最易受累。结论:高血压、糖尿病和(或)高脂血症为绝经前女性冠心病重要危险因素。冠状动脉病变程度与高脂血症密切相关。绝经前女性典型心绞痛伴ST-T改变应高度怀疑冠心病。冠脉病变以单支局限性病变多见,前降支最易受累。单独T波改变不能反映冠脉有无狭窄。

Objective：To study the clinical characteristics and risk factors in premanopausal women with coronary heart disease （CHD）. Methods ：Eighty six premanopausal female hospitalized patients with chest pain during 2003-01 2007-01 were classified in CHD group and contrast group by coronary angiography （CAG）. Risk factors,clinical symptoms and CAG characteristics were analyzed retrospectively. Results：40 cases in coronary group with average age 42.6± 5.8 years ,46 cases in contrast group with average age 43.8±4.6 years. The incidence of hypertension,diabetes and hyperlipidernia were significantly higher than that of contrast group （67. 5% vs 13. 0%, 50. 0% vs 8. 7%, 55.0% vs 13.0%）（P〈0. 05）. In TC,TG,HDL-C and Lp（a） , there were statistics differences between two groups （P〈0. 05） . No difference in CHD family history,smoking. In TC, LDL-C , Lp （a）, there were statistics differences between single vessel lesion and multi-vessel lesion （P〈0.05）. Typical angina pectoris and ECG changes were more common in CHD group （30/40 cases ,75% vs 4/46 cases,8.7%;34/40cases,85% vs15/46 cases , 32. 6 % ）. Single T-wave change was more common in contrast group （8/34 cases, 23.5 0% vs 12/15 cases, 80% ）. Single vessel localized lesion was common in CHD group. Left anterior disending artery was the most frequently involved vessel. Conclusion：Hypertension,diabetes and/or hyperlipidemia are major risk factors in premanopausal women with CHD. The extent of coronary artery lesion is closely related to hyperlipoidemia. Premanopausal women with typical angina pectoris and ST-T changes should be suspected CHD. Single vessel localized stenosis in LAD is typical lesions in CHD group. Single T-wave change don＇t reflect stenosis of coronary artery.