年龄≤50岁女性冠心病患者危险因素及冠状动脉造影特点

Risk factors, clinical and angiographic features of women aged 50 or less with coronary artery disease

目的探讨年龄在50岁及以下的女性冠心病患者的危险因素、临床及冠状动脉造影特点。方法选取经临床及冠状动脉造影确诊的50岁及以下女性冠心病住院患者共173例作为疾病组,同期收治的50岁及以下冠状动脉造影正常的非冠心病住院患者共494例作为对照组,对比分析两组间冠心病危险因素、临床及冠状动脉造影特点。结果疾病组中糖尿病患者、冠心病家族史患者、血脂异常患者及高血压患者比例均明显高于对照组(P<0.05),且疾病组患者舒张压、空腹血糖值也明显高于对照组(P<0.05),而体重、收缩压、停经年龄等则与对照组差异无统计学意义(P>0.05);疾病组血清总胆固醇、三酰甘油值明显高于对照组(P<0.05),而高密度脂蛋白、载脂蛋白A值则明显低于对照组(P<0.05);尿蛋白阳性患者比例,疾病组明显高于对照组(P<0.05);而血清尿酸、肌酸酐(肌酐)两组间比较差异无统计学意义;疾病组中,单支冠状动脉病变患者占53.8%;多支病变患者占31.2%;冠状动脉轻度狭窄或正常患者占15.0%。受累的冠状动脉以左前降支及其分支最多,其次为右冠状动脉及其分支。结论 50岁及以下女性冠心病患者的主要危险因素为糖尿病、冠心病阳性家族史、血脂异常、高血压(尤其是舒张压高)及尿蛋白阳性。单纯停经而没有伴随冠心病其他危险因素,可能不会导致冠心病发病率的增加。这些患者冠状动脉病变以单支病变最多见,相当部分患者冠状动脉仅轻度异常甚或未见异常。

Objective To investigate the risk factors, clinical and angiographic features of women aged 50 or less with coronary artery disease（CAD）. Methods One hundred and seventy-three female CAD patients comifrmed by coronary angiographic aged 50 or less were classiifed as group A, while another 494 non-CAD women aged 50 or less as group B. The differences in CAD risk factors, clinical and angiographic features between the 2 groups were analyzed. Results There were more women with diabetes, positive CAD family history, dyslipidemia or hypertension （especially diastolic hypertension） in group A than in group B. Patient in group A had higher diastolic pressures and serum glucose level than those in group B but both groups had similar body weights, systolic pressures and menopause ages. The serum total cholesterol and triglyceride levels were higher in patients in group A than those in group B while high-density-lipoprotein （HDL） cholesterol and apolipoprotein A levels were lower in group A. The low-density-lipoprotein （LDL） and apolipoprotein B were higher in group A than in group B but without＆amp;nbsp;signiifcance. There were more women with positive urine protein in group A than in group B. In group A, more than 50%of patients were with single diseased artery while another 15%with slight coronary artery atherosclerosis or even normal arteries. Most of the lesions were found in left anterior descending artery （LAD） and its branches. Conclusions Risk factors of CAD included diabetes, positive CAD family history, dyslipidemia, hypertension（especially diastolic hypertension） and positive urine protein in women aged 50 or less Menopause alone, without other CAD risk factors, would not lead to CAD. Single vessel disease was more commonly found in this group of patients.