中国急性心肌梗死患者心血管危险因素分析

Cardiovascular Risk Factor Analysis for Acute Myocardial Infarction Patients in China

目的:描述中国急性心肌梗死(AMI)患者心血管危险因素的分布情况。方法:采用中国AMI注册登记(CAMI)研究的数据,选取从2013-01-01至2014-03-31期间全国31个省、市和自治区的107家医院连续入选的AMI患者(包括ST段抬高型心肌梗死和非ST段抬高型心肌梗死),入选患者从发病至医院就诊的时间在7天之内。危险因素采用调查问卷的方式收集。可纠正危险因素包括吸烟、超重/肥胖、高血压、血脂代谢异常、糖尿病;生活方式危险因素包括缺乏运动、喜食肥腻食物;不可纠正危险因素包括早发冠心病家族史。结果:该研究共收集17 773例AMI患者,在数据资料填写完整并纳入分析的15 998例(90%)患者中,71.1%为ST段抬高型心肌梗死,74.0%为男性,平均年龄为(61.8±15.0)岁,平均体重指数为(24.6±12.2)kg/m2。在可纠正的心血管危险因素中,吸烟(54.4%)、超重/肥胖(53.9%)和高血压(51.2%)位居前三,其次为糖尿病(19.5%)和血脂代谢异常(7.7%)。26.6%的AMI患者有≥3个可纠正的危险因素,而8.7%的AMI患者没有任何可纠正的危险因素。3.6%的患者有早发心血管病家族史。76.2%的患者经常进食肥腻饮食,79.6%的患者缺乏运动。与男性患者相比,女性患者年龄较高[(67.4±14.4)岁vs(59.8±14.8)岁],合并高血压(61.8%vs 47.5%)和糖尿病(25.5%vs 17.4%)的患者更多;而男性患者中正在吸烟/有吸烟史(69.2%vs 12.1%)和有血脂代谢异常病史的患者(8.1%vs 6.7%)显著多于女性(P均<0.05)。≤55岁的患者占27.9%,其中男性(88.9%vs 68.2%)、体重指数[(25.2±8.4)kg/m2 vs(24.4±13.3)kg/m2]、血脂代谢异常(10.0%vs 6.8%)、吸烟(70.1%vs 48.3%)、有早发心血管家族史(6.6%vs 2.4%)和肥腻饮食(83.4%vs 73.4%)的患者比例均高于年龄>55岁的患者(P均<0.05);而>55岁的患者中合并高血压(55.3%vs 40.7%)和糖尿病(21.1%vs 15.2%)的患者比例高于≤55岁患者(P均<0.05)。结论:超过1/4的中国AMI患者有≥3个可纠正的心血管危险因素,半数以上AMI患者有吸烟史、超重/肥胖和高血压;近80%的AMI患者有肥腻饮食和缺乏运动等不良生活方式。

Objective： To describe the cardiovascular risk factor distribution for acute myocardial infarction （AMI） patients m China. Methods： Based onthe information of Chinaacute myocardial infarction （CAMI） registry, we studied 17773 consecutive AMI patients from 107 hospitals among 31 provinces, cities and autonomous districts nationwide form 2013- 01-01 to 2014-03-31. The patients included STEMI and non-STEMI, they were admitted within 7 days of onset and thecardiovascular risk factors were collected by questionnaire survey. The reparable risk factors were defined as smoking, over weight/obese, hypertension, dyslipidemia, diabetes, unhealthy living style as lack of excise and taking greasy food; un-reparable risk factor was defined asthe family history of premature CAD. Results：There were 15998/17773 （90%） AMI patients with entire information enrolled for analysis, of whom 71.1% with STEMI and 74.0% with non-STEMI at the mean age of （67.4 ±14.4） years and mean BMI of （24.6±12.2） kg/m^2. The first 3 reparable risk factors were smoking （54.4%）, weight/obese （53.9%） and hypertension （51.2%）, followed by diabetes （19.5%） and dyslipidemia （7.7%）. There were 26.6% AMI patients with〉3 reparable risk factors, 8.7% without reparable risk factor; 3.6% with the family history of premature CAD. There were 76.2% of patientstaking moregreasy food, 79.6% lack of excise. Compared with male patients, female were with elder age （67.4 ±14.4） years vs （59.8 ±14.8） years, more hypertension （61.8% vs 47.5%） and more diabetes （25.5% vs 17.4%）; while male patients were more with smoking history （69.2% vs 21.1%） and dyslipidemia （8.1% vs 6.7%）, all P〈0.05. There were 4458/15998 （27.9%） patients 〈 55 years of age, compared with those 〉 55 years, they were more with male gender （88.9% vs 68.2%）, higher BMI （25.2 ±8.4） kg/m^2 vs （24.4 ±13.3） kg/m^2, more dyslipidemia（10.0% vs 6.8）, more smokers （70.1% vs 48.3%）, taking more greasy food （83.4% vs 73.4%）, and more family history of premature CAD （6.6% vs 2.4）; while the patients 〉 55 years were more with hypertension （55.3% vs 40.7%） and diabetes （21.1% vs 15.2%）, all P〈0.05. Conclusion： There are more than 1/4 AMI patients having ≥3 reparable risk factors, more than half AMI patients having smoking history, over weight/obese and more than 80% of patients taking more greasy food and lack of excise.