围绝经期女性冠心病危险因素及发病特点

Risk factors and characteristics of coronary heart disease in perimenopausal women

目的探讨围绝经期女性冠心病危险因素和发病特点。方法选择经冠脉造影初次确诊的围绝经期冠心病女性患者60例(研究组),同期入院的老年女性冠心病患者(绝经后,年龄>60岁,老年组)80例及同年龄段男性冠心病患者82例(男性组)作为对照组。比较3组患者危险因素(高血压、糖尿病、吸烟和家族史、血脂)、心电图、冠脉病变的差异。结果研究组总胆固醇、低密度脂蛋白水平低于老年组,差异有统计学意义(P<0.05);吸烟患者比例低于男性组,高密度脂蛋白高于该组,差异显著(P<0.01);其他危险因素与对照组无统计学差异。研究组心电图阳性率显著低于老年组(56.7%vs.87.5%,P<0.01),与男性组比较无差异。冠状动脉造影显示研究组以单支病变为主(50.0%),冠脉Gensini积分低于对照组,差异有统计学意义;研究组接受冠脉介入治疗比例与对照组无差异,冠状动脉旁路移植术则显著少于老年组(6.7%vs.35.0%,P<0.01)。结论高血压、糖尿病、家族史是围绝经期女性冠心病的重要危险因素,该阶段心电图阳性率低,冠脉病变相对较轻,但仍有相当多患者需介入治疗,应重视早期预防和治疗。

Objective To discuss the risk factors and characteristics of coronary heart disease（CHD） in perimenopausal women.Methods The female patients with CHD diagnosed by coronary angiography（CAG） for the first time were selected as the experimental group（n=60）.The female and aged patients with CHD hospitalized at the same time（after menopause,older than 60,n=80,aged group）,and male patients with CHD at the same ages（n=82,male group） were selected as control groups.The differences in risk factors（hypertension,diabetes,smoking,family history and blood fat）,electrocardiogram（ECG） and coronary lesions were compared in 3 groups.Results In experimental group,the levels of total cholesterol（TC） and low-density lipoprotein（LDL） were lower than those in aged group（P0.05）,proportion of smoking patients was significantly lower and high-density lipoprotein（HDL） was higher than those in male group（P0.01）,and other risk factors had no statistical differences.The positive rate of ECG was significantly lower in experimental group than that in aged group（56.7% vs.87.5%,P0.01） and had no difference compared with male group.The results of CAG showed that the coronary lesions were mainly single vessel lesion（50.0%）,and coronary integral was lower in experimental group than that in control groups with statistical difference.The proportion of cases with percutaneous coronary intervention had no difference between experimental group and control groups,and cases of coronary artery bypass grafting were much less in experimental group than those in aged group（6.7% vs.35.0%,P0.01）.Conclusion Hypertension,diabetes and family history are important risk factors of CHD in perimenopause woman.The positive rate of ECG is low and coronary lesions are relative mild,but there are still many patients needing intervention treatment.More attention should be paid to early prevention and treatment.