急性心肌梗死伴肥胖的临床特点及冠脉病变特征

Clinical and coronary artery lesion features in acute myocardial infarction patients with obesity

目的:探讨急性心肌梗死(AMI)伴肥胖患者的临床特点及冠脉病变特征,提高对其认识,探讨早期防治的意义.方法:对208例AMI患者,据体重指数(BMI)、腰围(WC)分为肥胖组66例,非肥胖组142例,对两组病人的临床特点及冠脉造影结果进行分析.结果:肥胖组发病年龄显著低于非肥胖组(P<0.01),肥胖组高血压、糖尿病、血脂异常、家族史、既往心绞痛史、大面积心肌梗死发生率、肌酸磷酸肌酶-同功酶(CK-MB)均显著高于非肥胖组(P<0.01),肥胖组心肌肥厚、心力衰竭、心律失常、心源性休克、住院死亡率均显著高于非肥胖组(P<0.05),肥胖组左室射血分数(LVEF)值显著低于非肥胖组(P<0.01).冠脉造影结果显示:肥胖组三支病变、弥散性病变、血管中重度狭窄病变、左主干病变发生率均高于非肥胖组(P<0.01).结论:肥胖常与高血压、脂代谢紊乱、糖尿病等心血管危险因素同时存在,肥胖伴AMI患者心功能差,住院并发症及死亡率均高,冠脉病变复杂严重.

AIM： To study the clinical and coronary artery lesion features in acute myocardial infarction （AMI） patients with obesity, so as to improve the understanding of the significance of early prevention and treatment. METHODS： According to body mass index （BMI） and waist circumference （WC）, 208 patients with AMI were divided into 2 groups, obesity group （66 cases） and non-obesity group （ 142 cases）. The clinical features and the results of coronary angiography in the 2 groups were analyzed respectively. RESULTS ： The age of onset in obesity group was significantly younger than that in the non-obesity group （P 〈 0.01 ） ; the incidences of hypertension, diabetes, lipid disorders, family history, past history of angina, large myocardial infarction, muscle enzyme creatine phosphate-isoenzyme （CK-MB） in the obesity group were significantly higher than those in the non-obesity group （ P 〈 0.01 ） ; the incidences of myocardial hypertrophy, heart failure, arrhythmias, cardiac shock, in-hospital death in the obesity group were significantly higher than those in the non-obesity group （P 〈 0. 05 ）; the value of left ventricular ejection fraction （LVEF） was significantly lower than that in the non-obesity group （P 〈 0.01 ）. The results of coronary angiography showed that the incidences of three-branch lesions, diffuse lesions, severe stenosis lesions, left main lesions were higher than those in the non-obesity group （ P 〈 0.01 ）. CONCLUSION ： Obesity is often associated with high blood pressure, lipid metabolism disorders, diabetes and other cardiovascular diseases. Obesity patients with AMI have poor heart function and high incidence of complications and inhospital death. Their coronary artery lesions are complex and serious.