舟山群岛急性冠脉综合征青年患者心律失常发生的类型及危险因素分析

Types and risk factors of arrhythmia in young patients with acute coronary syndromes occurred on Zhoushan Islands

目的探讨2008年9月至2012年6月舟山群岛44岁以下的青年急性冠脉综合征（ACS）患者，入院期间发生心律失常的类型特征及危险因素，为预防猝死提供方案支持。方法从舟山市人民医院的病历信息系统与远程会诊信息中心的城乡会诊信息系统调取舟山群岛44岁以下的青年急性冠脉征患者，以及同期住院的中年ACS患者和老年ACS患者的信息资料，从心电不稳定、泵衰竭和交感神经兴奋、心动过缓和传导阻滞三大类别分析患者的心律失常类型；从患者的一般情况、心律失常类型、高血压情况、空腹血糖、甲状腺疾病、呼吸睡眠暂停综合征、吸烟史、饮酒史、饮食习惯、早发心律失常家族史、实验室检查等分析患者的危险因素。结果2008年9月至2012年6月，舟山群岛发生急性冠脉征的青年患者共110例，出现心律失常的75例，明显低于同期因ACS住院的老年患者（54．55％vs．70．00％，P〈0．01）；青年ACS组窦速的发生率最高，与中年ACS组（30．91％vs．21．67％，P〈0．01）和老年ACS组（30．91％vs．20．00％，P〈0．01）比较差异具有统计学意义。青年ACS心律失常组与青年ACS非心律失常组、中年ACS心律失常组、老年ACS心律失常组比较，吸烟比例明显增高（78．57％vs．32．5％V8．51．25％vs．55．56％，均P〈0．01）。建立logistie回归后发现与舟山群岛青年ACS患者发生心律失常独立相关的危险因素依次是：冠脉病变支数（OR=24．293）、甲状腺功能异常（OR=20．353）、吸烟（OR=1．112）、饮酒（OR=1．039）、睡眠呼吸暂停综合征（OR=1．356）。结论舟山群岛44岁以下的青年ACS患者，心律失常的出现类型以窦性心动过速、室性早搏、房颤／房扑为主。冠脉病变支数、甲状腺功能异常、吸烟是造成其心律失常的主要危险因素。提示治疗青年ACS患者时，应注重B受体阻滞剂的应用，同时宣传健康生活方式。

Objective To investigate the types and risk factors of arrhythmia induced by acutecoronary syndrome （ACS） in young adult patients under the age of 44 years in order to design a strategy to prevent from sudden death. Methods Data of young adult patients suffered from cardiac arrhythmia induced by ACS admitted from September 2008 to June 2012 were obtained from the medical records information system and tele-consultation information center of Zhoushan People＇s Hospital. Data of another 180 middle aged ACS patients and 150 elderly ACS patients hospitalized at the same period were served as controls. Analyzed from ECG instability, pump failure and sympathetic activity, bradycardia and conduction block three categories to analyze the type of arrhythmia in patients. The risk factors of cardiac arrhythmia were searched among many possible factors such as the general condition of the patients, types of arrhythmia, level of blood pressure, concentration of fasting blood sugar, thyroid disease, sleep apnea syndrome, history of smoking and drink, eating habits, family history of early-onset arrhythmia, and the results of other special laboratory tests. Results From September 2008 to June 2012, the total cases of Zhoushan Islands young patients with ACS were 110 cases. Of them, 75 had cardiac arrhythmia, which was significantly lower than that in elderly ACS patients （54. 55% vs. 70. 00%, P 〈 0. 01 ） ; The main type of cardiac arrhythmia in young adult ACS patients was sinus tachycardia, which was significantly higher than that in middle-aged ACS patients （30.91% vs. 21.67%, P 〈0.01） and in elderly ACS patients （30.91% vs. 20.00%, P 〈 0. 01 ）. Compared with young ACS patients without arrhythmia, middle age ACS patients with arrhythmia, and elderly ACS patients with arrhythmia, the rate of smoking was significantly higher in young adult ACS patients with arrhythmia （78. 57% vs. 32. 5% vs. 51.25% vs. 55.56%, P 〈0. 01 ）. Logistic regression analysis showed that the number of diseased coronary vessels （ OR = 24. 293 ）, thyroid dysfunction （ OR -- 20. 353）, smoking （OR = 1. 112）, alcohol drinking （OR = 1. 039） and obstructive sleep apnea syndrome （ OR = 1. 356） were independent risk factors for developing arrhythmia in young ACS patients from Zhoushan Islands. Conclusions The main types of arrhythmia are sinus tachycardia, premature ventricular contractions, atrial fibrillation/atrial flutter found in young adult ACS patients under the age of 44 from Zhoushan Islands and the major risk factors related to the arrhythmia genesis are number of diseased coronary vessels, thyroid dysfunction and smoking. The data remind us that treating young patients with ACS should focus on the application of 13-blockers and improvement of healthy lifestyle.