老年与青年急性心肌梗死患者相关因素的分析

Analysis on Related Factors among Young and Elderly Patients with Acute Myocardial Infarction

目的探讨急性心肌梗死(AMI)45岁以下患者和60岁以上患者的危险因素和临床特点。方法将确诊为AMI<45岁的68例患者(青年组)与>60岁的171例患者(老年组)进行对照研究,分析其危险因素、冠状动脉病变和30天不良事件率等特点。结果青年组男性比例、吸烟者和高脂血症者较老年组多,而青年组糖尿病、高血压和慢性肾功能不全低于老年组,差异均有统计学意义(P<0.01)。老年组发生30天不良事件高于青年组(P<0.05)。老年组和青年组30天不良事件发生组Killip分级≥3级和多支病变者更多,而LVEF值则更低。老年组中,30天不良事件发生组糖尿病者比例、高脂血症者比例、CKMB高峰值水平皆高于未发生组。结论吸烟、高脂血症和性别为青年AMI的主要危险因素,而老年AMI则较多合并高血压、糖尿病和慢性肾功能不全。killip分级、冠状动脉病变的严重程度和左心室收缩功能仍为影响预后的重要因素。

Objective To explore the risk factors and clinical features of acute myocardial infarction （AMI） among young and elderly patients. Methods A case-control study was conducted involving 68 young patients （〈45 ） and 171 elderly patients （＆gt;60 ） with clinical diagnosis of AMI.The differences of risk factors ,clinical characteristics were analyzed between the two groups.Results Com-pared with the group with elderly patients ,the risk factors of smoking and hypercholesterolemia were more frequently found among the young patients（P〈0.01） ,but the rates of hypertension、diabetes and chronic kidney disease were lower（P〈0.01）.AMl patients of male were more for youth than for elderly （P〈0.01）.The 30-day major adverse clinical outcome （MACO）was significantly lower in the young patients than in the elderly patients （ P〈0.05）. Either young or elderly AMI patients ,the incidence of an advanced Killip score （defined as ≥ score 3 upon presentation ） and multiple vessel disease were significantly higher in group with 30-day MA-CO than in group without 30-day MACO ,whereas left ventricular ejection fraction （LVEF） were significantly lower.In the elderly AMI patients ,the rates of diabetes、hyperlipidaemia and peak CKMB level were significantly higher in group with 30-day MACO than in group without 30-day MACO. Conclusions Smoking ,hypercholesterolemia and gender are the major risk factors for AMI among indi-viduals below the age of 45.Elderly AMI patients mostly combined with hypertension ,diabetes and chronic kidney disease.Advanced Killip score ,the severity of coronary artery disease and LVEF are the important factors for prognosis.