青年和老年急性冠脉综合征患者危险因素及冠脉造影特点的对比研究

Risk factors and coronary angiographic findings in young and elderly patients with acute coronary syndrome： a comparative study

目的探讨青年和老年急性冠脉综合征（ACS）患者危险因素与冠脉造影特点。方法将临床确诊为ACS、年龄〈45岁的69例患者（青年组）与65岁以上的421例患者（老年组）进行病例对照研究，分析其危险因素、临床特征、冠脉造影病变程度、经皮冠状动脉介入治疗（PCI）效果，以及相关因素的不同特点。结果青年组与老年组比较，ACS危险因素中吸烟史、阳性家族史明显升高，而合并高血压、糖尿病则低于老年组。血脂谱分析显示，青年患者TG、LDL—C、ApoB显著高于老年组，HDL—C则相反。冠脉造影显示，青年组单支病变（73．9％）明显多于老年组（28．0％），而双支病变（10．1％）、多支病变（15．9％）则显著少于老年组（27．1％、55．1％）；冠脉病变程度用改良的Genisi积分比较，青年组（7．68±5．31）显著低于老年组（16．61±7．82）。对多种危险因素进行相关性分析显示，LDL—C与改良的Genisi积分呈明显的正相关（r=0．287，P=0．041）。HDL—C（r=-0．581，P=-0．01）、ApoA—I（r=-0．357，P=-0．025）与改良的Genisi积分明显负相关。结论吸烟、早发冠心病家族史、代谢紊乱是青年ACS的主要危险因素；青年ACS患者冠脉病变程度显著低于老年组，介入治疗成功率也高。

Objective To study the risk factors for acute coronary syndrome （ACS） and summarize the features of coronary angiographic （CAG） findings in young and elderly patients. Methods A case-control study was conducted involving 69 young（below 45 years） and 421 elderly （65 years and over） patients with clinical diagnosis of ACS. 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 ,hut the rates of hypertention and diabetes were lower. The levels of triglyceride（TG）, low-density lipoprotcin cholesterol（ LDL-C ） and apolipoprotein B （ApoB） were signifi- cantly higher, while high-density lipoprotein cholesterol （HDL-C） was lower in the young patients than elderly patients. Anglography identified higher incidence of one-vessel disease in the young patients （73.9% vs 28.0% ）, but the incidence of double-vessel and multi-vessel disease was more frequent in the elderly patients （10.1% vs 27.1% and 15.9% vs 55.1% ）. Modified Gensini score of coronary angiography was lower in the young patients （7.68±5.31 vs 16.61±7.82）. Correlation analysis showed that LDL-C （r=0.287,P=0.041） was positively correlated, while HDL-C （r =-0.581,P=0.01 ）, ApoA-I （r =-0.357,P=0.025 ）were inversely correlated to the angiographic score. Conclusion Smoking, metabolic disorders and positive family history are the major risk factors for ACS among individuals below the age of forty-five, who often have milder coronary artery stenosis than elderly patients.