40岁以下急性心肌梗死患者临床诊治探讨

Clinical features of patients younger than 40 years old with acute myocardial infarction

目的探讨40岁以下急性心肌梗死（AMI）患者的临床及冠状动脉造影特点。方法2010年10月至2011年9月因胸痛或胸部不适就诊于北京军区总医院行急诊冠状动脉造影确诊的AMI患者117例，对年龄≤40岁的患者的临床及冠状动脉造影特点进行回顾性分析。结果117例AMI患者中，9例患者年龄≤40岁，占7．7％。9例患者均为男性，平均年龄（35±5）岁；其中8例患者存在吸烟史，2例患者有饮酒史，2例患者有高血压病史；均无糖尿病和高脂血症病史。生化检查情况：平均LDL—C水平为（3．1±0．9）mmol／L，平均血cr水平为（76±11）μmol／L，平均血尿酸水平（309±64）μmol／L，平均C反应蛋白水平（7．43±5．53）mg／L。7例患者为急性ST段抬高型心肌梗死，2例患者为急性非ST段抬高型心肌梗死，冠状动脉造影示罪犯血管有3例为前降支，4例为右冠状动脉，1例为回旋支；1例为前降支＋右冠状动脉。8例患者进行了经皮冠状动脉介入治疗。结论40岁以下AMI患者多为急性ST段抬高型心肌梗死，以单支、阻塞性病变常见，吸烟是主要易患因素。

Objective To explore the clinical and coronary angiographic features of patients with acute myocardial infarction（AMI） who were younger than 40 years old. Methods Totally 117 AMI patients underwent coronary angiography due to chest pain or discomfort in the military general hospital of Beijing PLA from October 2010 to September 2011 were reviewed. The clinical and coronary angiographic features of patients ≤40 years old were ana- lyzed. Results Among all the 117 patients with AMI, 9 cases （7.7%） were younger than 40 years old with a mean age（ 35 ± 5 ） years, and all were male. Eight cases of them have history of smoking. There were smoking histo- ry in 8 patients, drinking history in 2 patients, hypertension history in 2 patients, no diabetes mellitus and hyperlipi- demias history in all 9 patients. The level of low density lipoprotein cholesterol（LDL-C） in blood was （3.1 ±0.9 ） retool/L, the level of serum creatinine （ Cr ） was （ 76 ± 11 ） μmol/L, the level of unic acid was （ 309 ± 64 ） μmol/L, and the level of C reactive protein （CRP） was （ 7.43 ± 5.53 ） mg/L. There were 7 cases of ST-segment elevated myocardial infarction and 2 cases of non- ST-segment elevated myocardial infarction. The culprit vessels were as fob lows： 3 left anterior descending artery, 4 right coronary artery, 1 left circumflex branch, 1 left anterior descending artery with right coronary artery. 8 patients underwent percutaneous coronary intervention. Conclusions The majority of patients ≤40 years old with acute myocardial infarction are characterizwed with ST-segment elevated and single coronary artery obstructive lesion. Smoking is the main risk factor.