不同年龄组急性冠状动脉综合征患者的危险因素、冠状动脉病变特点及预后的调查分析

Clinical Study of risk factors,features of coronary artery and prognosis of hospitalized patients with acute coronary syndrome in different age groups

目的：探讨不同年龄组急性冠状动脉综合征（ACS）住院患者的危险因素、冠状动脉病变特点及预后。方法：选择BRIG基线资料中,接受导管检查的963例患者,将其按年龄分组分为5组,〈45岁组83例、45-54岁组194例、55-64岁组281例、65-74岁组290例、〉75岁组115例,回顾性分析其危险因素、冠状动脉病变特点及住院期间主要不良心脑血管事件（MACCE）发生率及药物的临床应用情况。结果：①ACS患者中以男性为主（男女之比76.5%∶23.5%,P〈0.01）,其中女性患者比例随年龄增加而逐渐增高,〈45岁组与45～54岁组差异有统计学意义（P〈0.05）,〉55岁的3组与〈55岁的2组之间差异均有统计学意义（P〈0.01）。②年龄〈45岁组与45～54岁组患者多与吸烟、冠心病家族史有关,其余3组与高血压、糖尿病有关。③〉75岁组患者中血肌酐明显升高,并且与其他各组间差异有统计学意义（P〈0.01）;血尿酸也升高,与45～54岁组、55～64岁组差异有统计学意义（P〈0.05,P〈0.01）。④冠状动脉病变支数随年龄增加而增加,年龄〈45岁组以单支病变为主,与其余4组差异均有统计学意义（P〈0.01）;65～74岁组及〉75岁组患者以3支病变为主,与其他3组差异均有统计学意义（P〈0.01）。⑤病变类型、血运重建成功率各组间差异无统计学意义（P〉0.05）。⑥不同年龄组患者用药情况：β-受体阻滞剂在年龄〈45岁组和55～64岁组患者与65～74岁组及〉75岁组患者存在差异（P〈0.05）;低分子量肝素在45～54岁组患者与65～74岁组患者存在差异（P〈0.05）;阿司匹林、ACEI/ARB和他汀类调脂药应用无差异（P〉0.05）;⑦不同年龄组患者住院期间主要事件的发生率或再发心肌梗死联合事件发生率均无差异（P〉0.05）;但死亡有差异（P〈0.01）。Logist多因素回归分析发现,除年龄外,肾功能下降（P〈0.01）是独立危险因素。结论：不同年齢组ACS患者的危险因素及冠状动脉病变有不同的特点,除综合干预危险因素外,应针对不同年龄组ACS患者的冠状动脉病变特点采取相应的干预措施。

Objective：To analyze the risk factors,feature of coronary artery and prognosis of acute coronary syndrome（ACS） inpatients in different age groups.Method：The study is a retrospective registered study including 963 patients received catheterization from BRIG study.963 patients were divided into groups by age as： age45 years（n=83）,45-54 years（n=194）,55-64 years（n=281）,65-74 years（n=290）,75 years（n=115）,We retrospectively analyzed the difference in risk factors,feature of coronary artery and major adverse cardiac and cerebral vascular events（MACCE） and the status of application of drugs in the different age groups.Result：① Most of patients are male（male to female ratio of 76.5% vs 23.5%,P0.01）;of which the proportion of female patients increased with adding age,there was significant difference between 45 years group and 45-54 years group（P0.05）;there was significant difference between 55 years three groups and 55 years groups（P0.01）.②The major risk factors were smoking,family history of coronary artery disease in age（45 years group and 45~54）;the major risk factors were hypertension and diabetes in other three groups.③Serum creatinine significantly increased in 75 years group compared with other groups（P0.01）;blood uric acid also increased significantly compared with 45-54 age group and 55-64 age group（P0.05,P0.01）.④The number of stenosis vessels increased with adding age.Patients in 45 age group mainly have single-vessel lesions,and there were significantly differences compared with the other four groups（P0.01）;patients in 65-74 age group and 75 years group mainly have three vessel lesions and there were significantly differences compared with the other three groups（P0.01）.⑤There were no significant differences in the lesion type and the success rate of revascularization（P0.05）.⑥There were significant differences in application of β-receptor blockers in 45 years group and 55-64 years group compared with 65-74 years group and 75 years group（P0.05）;there were differences in application of low molecular weight heparin between 45-54 years group and 65-74 age group（P0.05）;⑦There was no difference in the incidence of major events in different age groups（P0.05）;but in death（P0.01）.Multivariate logistic regression analysis showed that besides age,decreased renal function were associated independently with in-hospital mortality（P0.01）.Conclusion：There are different risk factors and characteristics of coronary lesion among ACS patients with different ages.It is appropriate to adopt different interventinal strategy accoding to the coronary features in ACS patients with different ages.