单中心10年40岁以下急性心肌梗死患者临床特征与治疗现状分析

The clinical and therapeutic features of acute myocardial infarction in patients less than 40 years old:10 years of experience in a single center

目的：分析单中心10年来40岁以下急性心肌梗死（acute myocardial infarction,AMI）患者的发病诱因。梗死部位及治疗方式选择等特点。方法：收集并分析1999年1月~2009年1月诊断为AMI的青年（≤40岁）患者的临床资料,收集同期老年（60~75岁）患者进行配对比较。结果：青年组106例,老年组112例。46.23%的青年人无明确的病因,饮酒为其独特的诱因。青年组以前壁受累为主,其次为下壁/后壁;而老年组以下壁/后壁受累为主,其次为前壁。与老年组相比,青年组左室收缩末期内径较小（P 〈 0.01）,而左室射血分数无明显差异。青年组单纯溶栓治疗。溶栓治疗 ＋ 择期支架植入治疗率明显较老年组高（P 〈 0.01）。结论：青年人应注重体检,改善生活方式。青年AMI较多累及前壁,临床治疗虽积极,但与指南推荐仍有较大差距,部分医院应加快绿色通道建立,使更多患者获益。

Objective：The purpose of this single center study was to investigate the characteristics of predisposing factors,location of infarction selection of treatment and etc. in patients younger than 40 years with acute myocardial infarction（AMI）. Methods：We collected and analyzed the clinical data of 218 patients with AMI from January 1999 to January 2009. All characteristics were compared between young （≤40 yrs） and elder patients（60~75 yrs）. Results：There were 106 cases in the young group and 112 cases in the elder group. There were 46.23% patients in the young group without a clear etiology,and drinking was one of the distinctive predisposing factors for young patients. For the young group,AMI was localized in 54.64% anterior wall,followed by 48.45% inferior and posterior wall;however,for the elder group,AMI was localized mainly in 58.33% inferior and posterior wall. Compared with the elder group,the left ventricular end-systolic diameter in the young group was smaller （P 〈 0.01）,while with no significant difference in left ventricular ejection fraction. Young patients were more likely to be treated with thrombolytic therapy,thrombolytic therapy plus selective stent implantation than the elder patients. Conclusion：Young people should pay attention to physical examination and improve the lifestyle. Young patients are more likely to have AMI in the anterior wall. Although clinical treatment is positive,it is still has a big disparity compared with the guidelines recommendation. Hospitals should speed up the establishment of green channel to benefit more partients.