青年和老年急性心肌梗死患者危险因素及冠状动脉造影特点的对比分析

Risk factors and coronary angiographic findings in young and elderly patients with acute myocardial infarction:a comparative analysis

目的探讨青年与老年人群中急性心肌梗死(AMI)患者危险因素与冠状动脉造影特点。方法将临床确诊为AMI小于40岁的53例(青年组)与60岁以上的438例(老年组)进行病例对照研究,分析其危险因素、临床检查、以及冠脉病变程度与相关因素的不同特点。结果青年组与老年组比较,AMI危险因素中吸烟史、阳性家族史明显增高,而合并高血压、糖尿病则低于老年患者。血脂谱分析显示青年患者TG、LDL-C、ApoB显著高于老年患者,而HDL-C则相反。冠脉造影显示青年组单支病变(73.33%)明显多于老年组(25.09%),而双支(11.11%)与多支病变(8.89%)则显著少于老年组(27.49%、47.01%);与之相应的冠脉病变程度用改良的Genisi积分比较,青年组(7.69±5.23)显著低于老年组(16.08±7.81)。对多种危险因素进行相关性分析显示LDL-C(r=0.289,P=0.046)与改良的Gensini积分呈明显正相关,HDL-C(r=-0.589,v=0.01)、ApoA-Ⅰ(r=-0.395,P=0.023)与改良的Gensini积分呈明显负相关。多元逐步回归分析发现,HDL-C对冠状动脉狭窄严重程度的影响呈现一定的线性负相关。结论吸烟、代谢紊乱和阳性家族史是40岁以下AMI的主要危险因素;青年AMI患者冠脉病变程度显著低于老年组,HDL-C变化对青年AMI冠状动脉狭窄严重程度具有重要的影响。

Objective To identify the risk factors for acute myocardial infarction （AMI） and summarize the features of coronary aogiographic （CAG） findings in young and elderly patients. Methods A case-control study was conducted involving 53 young （below 40 years） and 438 elderly （60 years and over） patients with clinical diagnosis of AMI. The differences in the risk factors, clinical characteristics and CAG findings were analyzed between the two groups. Results Compared with the elderly patients, the risk factors of smoking and positive family history was more frequently found among the young patients, but the rates of hypertention and diabetes were lower. The levels of triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C） and apolipoprotein B （ApoB） were significantly higher, while high-density lipoprotein cholesterol （HDL-C） lower in the young patients than in the elderly patients. Angiography identified higher incidence of one-vessel disease in the young patients （73..33% vs 25.09%）, but the incidence of double-vessel and multi-vessel diseases was more frequent in the elderly patients （11.11% vs 27.49%, and 8.89% vs 47.01%）, most commonly compromising the left anterior descending （LAD） coronary artery in both groups, Modified Gensini score of coronary angiography was lower in the young patients （7.69±5.23 vs 16.08±7.81）. Correlation analysis showed that LDL-C （r=0.289, P=0.046） was positively correlated, while HDL-C （r=-0.589, P=0.01）, ApoA- I （r=-0.395, P=0.023） were inversely correlated to the angiographic score. Multiple regression analysis showed a significant inverse linear correlation between HDL-C level and coronary artery stenosis. Conclusion Smoking, metabolic disorders and positive family history are the major risk factors for AMI among individuals below the age of forty, who often have milder coronary artery stenosis than elderly patients. HDL-C variation is significantly correlated to the degree of coronary artery stenosis in young patients with AMI.