青年初发急性心肌梗死患者的临床特征分析

Clinical characteristics of initial acute myocardial infarction in young patients

目的：探讨青年初发急性心肌梗死患者临床特征。方法入选2011年6月~2013年10月因初发ST段抬高心肌梗死（STEMI）入住徐州市中心医院心内科的青年患者42例（青年组），同期入院老年STEMI患者（老年组）52例作为疾病对照组，冠状动脉CTA检查排除冠心病人群20例作为健康对照组（对照组）。收集患者临床基本资料、冠状动脉造影结果、入院、出院GRACE积分，分析纳入青年组高敏C反应蛋白、血脂、脑钠肽（BNP）、Gensini积分、入院GRACE积分与老年组及对照组差别。结果青年组有诱因者占42.9%，老年组有诱因者占15.4%，两组有诱因患者构成比有统计学差异（P＜0.05）。青年组患者以男性为主，且吸烟史、饮酒史、冠心病家族史构成比较老年组患者高（P＜0.05），其胸痛等临床症状表现典型，冠状动脉病变支数少于老年组患者（P＜0.05）。相关分析表明，入院GRACE积分与高敏C反应蛋白、Gensini积分、高密度脂蛋白胆固醇呈负相关（P＜0.01），与BNP呈正相关（P＜0.01）；出院GRACE积分与高敏C反应蛋白、Gensini积分呈负相关（P＜0.01），与BNP、年龄呈正相关（P＜0.01）。结论青年初发AMI,以男性患者为主，多有明显家族史及诱因，有多种高危因素，冠状动脉造影检查结果多为单支病变，早期监测与干预可能改善预后。

Objective To discuss the clinical characteristics of initial acute myocardial infarction （AMI） in young patients. Methods The young patients （n=42） with initial ST-segment elevation myocardial infarction （STEMI） were chosen as young group from Jun. 2011 to Oct. 2013, 52 elderly patients with STEMI were chosen as elderly group, and other 20 cases without CHD after CTA were chosen as control group during the same period. The general data, outcomes of CAG, and admission and discharge GRACE integrals were collected. The difference in high-sensitivity C-reactive protein （hs-CRP）, blood fat, BNP, Gensini integral, and admission GRACE integral were analyzed between young group and elderly group or control group. Results There were 42.9%patients with indicators in young group and 15.4%in elderly group （P〈0.05）. In young group, most patients were male and the percentage of those with smoking history, drinking history and CHD family history were higher than those in elderly group （P〈0.05）, chest pain and other symptoms were typical, and lesion vessels of coronary artery were less than those in elderly group （P〈0.05）. The correlation analysis showed that admission GRACE integral was negatively correlated to hs-CRP, Gensini integral and HDL-C （P〈0.01）, and positively correlated to BNP （P〈0.01）. The discharge GRACE integral was negatively correlated to hs-CRP and Gensini integral （P〈0.01）, and positively correlated to BNP and age （P〈0.01）. Conclusion The young patients with initial AMI are mainly male and have family history, indicators and multiple high-risk factors. The outcomes of CAG show the coronary lesion are mostly single vessel lesion, and early monitoring and intervention may improve prognosis.