老年急性冠状动脉综合征患者性别分析

Analysis of acute coronary syndrome in the old men and the women

目的初步探讨老年急性冠状动脉综合征(ACS)患者冠状动脉病变程度以及危险因素的差异。方法选择年龄≥60岁的ACS患者462例,其中ST段抬高急性心肌梗死患者237例,非ST段抬高急性心肌梗死患者55例,不稳定性心绞痛患者170例,分析比较男性和女性患者ACS临床分型,高血压、糖尿病、高脂血症、吸烟等危险因素伴发情况,冠状动脉病变程度及各项生化指标。结果与男性比较,女性患者年龄、糖尿病、高脂血症明显升高(P<0.05,P<0.01);非ST段抬高急性心肌梗死、不稳定性心绞痛、2支病变、3支病变、≥2个危险因素、TC和LDL-C均明显升高,血尿酸及入院血清总胆红素明显降低(P<0.01)。结论男性多表现为ST段抬高,女性多表现为非ST段抬高。男性单支病变较多,女性多支病变及合并危险因素较男性多。应激情况下男性的氧化应激激活和抗氧化能力优于女性。

Objective To study the difference of risk factors and severity of coronary lesion be- tween old men and old women with acute coronary syndrome. Methods Four hundred and sixty- two patients with acute coronary syndrome who were older than sixty years were divided into the ST elevated myocardial infarction （STEMI） group, the non-ST elevated myocardial infarction （NSTEMI） group and the unstable angina pectoris（UAP） group. Some of them underwent diag- nostic coronary angiography. The risk factors included smoking, hypertension, type-2 diabetes mellitus, hyperlipidemia, etc. Total bilirubin, uric acid, sugar, TC, TG, HDL, and LDL were meas- ured. The comparison and analyses were done between the men and the women in all of the pa- tients. Results The rate of STEMI in old men was higher than that in old women, the rates of NSTEMI and UAP in old women were higher than those in old men （P〈 0.01）. The rate of the single-branch lesion in old men was higher than that in old women, the rates of the double-branch lesion and the three-branch lesion were on the contrary （P〈 0.01）. The women were older and had higher rates of type-2 diabetes mellitus and hyperlipidemia than the men,the men had higher rate of smoking than the women. In the acute stage, the levels of serum total bilirubin and uric acid in the men were higher than those in the women,the levels of serum TC and LDL were on the contrary. After 1 week, the level of serum total bilirubin in the men was lower than that in the women （P ~ O. 01）. Conclusion In the acute coronary syndrome of old patients, women have higher prevalence of coronary risk factors and more complicated coronary lesions than men.