青年人急性心肌梗死41例临床分析

Clinical Characteristics in 41 Young Adult Patients with Acute Myocardial Infarction

【目的】分析青年人（〈45岁）急性心肌梗死（AMI）发病的临床和冠状动脉病变特点，探讨其病因及防治措施。【方法】对41例青年人AMI和同期中老年（≥50岁）AMI患者进行回顾性分析，观察危险因素及诱因、临床表现、心电图、冠状动脉病变特点等。【结果】青年组危险因素主要为吸烟、高脂血症／肥胖；多在大量吸烟、暴饮暴食、过度劳累、精神紧张等诱因后发病，胸痛典型，并发症少，预后较好。心电图检查多表现为前壁和ST段抬高心肌梗死（STEMI）；冠状动脉造影检查提示病变血管以单支病变多见，主要累及左前降支（LAD），狭窄程度较轻，侧支循环少，很少累及主干。青年组冠脉造影正常7例（17％）亦明显高于中老年组（0例）。【结论】青年人AMI病因以动脉粥样硬化（83％）为主，各种诱因造成的冠状动脉痉挛或斑块破裂是发病的重要原因。掌握其临床特点有助于早期诊断，改变不良生活方式及减轻精神紧张有利于减少心梗的发生。

[Objective] To analyze the clinical characteristics of coronary arteries of young adult patients （under 45 years old） with acute myocardial infarction （AMI） in order to obtain the causes and preventive measurement of this disease. [Methods]The data of 41 young adult patients with AMI and 41 elderly AMI patients were analyzed retrospectively. Electrocardiogram （ECG）, risk factors and inducing factors, clinical manifestation, and coronary artery lesion features were observed in all of the patients mentioned above, [Results]The main cause of AMI in young adult patients was coronary spasm, mostly due to smoking, hyperlipidemia/obesity. This disease was accompanied with intense chest pains, and had less complications and better prognosis. Compared with the elderly patients, ECG examination in AMI patients in the young adult group mainly showed the front wall myocardial infarction and ST-elevation-AMI （STEMI）. Young adult patients u- sually had single vessel lesion, especially the left descending coronary artery （LAD）, the slighter stenosis in coronary artery, less compensatory circulation, and rare damage in the main coronary artery confirmed by coronary angiogram. Coronary angiography was normal in 7 patients （17%） of young adult patients, but none of the coronary angiography was normal in elderly adults, and there were significant differences between the two groups （ P 〈0.01）. [Conclusion]Atherosclerosis （AS） is the main cause of AMI in the young adult patients （83%）, and the coronary artery spasm or the rupture of the plaque induced by various inducing factors plays an important role in the pathological process. Understanding its clinical characteristics is useful for the early diagnosis. Changing harmful life style and relieving mental stress will be helpful for decreasing the incidence of AMI.