早发冠心病患者的临床特征和冠脉病变特点的性别差异分析

Sex differences in clinical and coronary artery features of patients with premature coronary heart disease

目的探讨早发冠心病患者的危险因素、临床症状和冠状动脉病变特点的性别差异。方法连续入选我科2009年5月-2014年10月经冠脉造影确诊的198例早发冠心病患者，分为男性组（年龄〈55岁,n=135）和女性组（年龄〈65岁,n=63）。观察两组在冠心病危险因素、临床症状和冠脉造影特点等方面的差异，探讨早发冠心病患者的性别特征。结果男性组吸烟（83% vs. 5%，P〈0.01）、肥胖（28% vs. 16%,P〈0.05）和饮酒的比例（39% vs. 2%,P〈0.01）显著高于女性组，而女性组高血压病患者的比例高于男性组（70% vs. 51%,P〈0.05）；两组糖尿病、血脂异常患者的比例之间差别无统计学意义。男性组血清三酰甘油水平较女性组高〔（2.0±1.4） mmol/L vs.（1.6±0.9） mmol/L,P〈0.05〕，而高密度脂蛋白胆固醇〔（1.03±0.23） mmol/L vs.（1.18±0.27） mmol/L,P〈0.01〕和载脂蛋白A水平〔（1.11±0.19） g/L vs.（1.20±0.23） g/L,P〈0.01〕和载脂蛋白A/B比值〔（1.4±0.5） vs.（1.6±0.5）,P〈0.01〕则均较女性组低。男性组危险因素聚集较女性组明显〔（1.9±1.0） vs.（ 1.1±0.8），P〈0.01〕；职业分布中，工人在两组所占比例均较高（50% vs. 40%）,但男女组间无显著差异。与男性组比较，女性下岗或无业比例较更高（12% vs. 30%,P〈0.01）；两组无胸痛比例（35% vs. 46 %）无显著差异，同时，男性患者出汗较为常见（44% vs. 29%,P〈0.05），而女性组心悸现象则较多见（7% vs. 22%,P〈0.01）。两组冠状动脉造影结果显示均以单支病变为主（49% vs. 60%），病变血管均以前降支最为多见（68% vs. 54%）。两组冠状动脉造影结果比较，病变血管数、罪犯血管分布和累及植入支架比例之间差别均无统计学意义。结论早发冠心病患者临床特征存在性别差异，但冠状动脉病变分布特征二者之间无显著差别。

AIM To evaluate sex differences in risk factors, clinical profiles, and coronary artery lesion in patients with premature coronary heart disease （PCHD）. METHODS A total of 198 consecutive patients with premature CHD who were confirmed by coronary angiography with I〉50% luminal stenosis were divided into female group （F group, 〈 55 years old, n = 63） and male group （M group, 〈 65 years old, n = 135） from May 2009 to October 2014 in our department. Differences in CE/D risk factors, clinical symptom and angiographic features between groups were observed and analyzed. RESULTS Compared to F group, the M group had a significantly higher prevalence of smoking （83 vs. 5%, P 〈 0. 01 ）, obesity （28 vs. 16%, P 〈0. 05）, and alcohol consumption （39 vs. 2%, P 〈0. 01 ） ; however, the F group showed a significantly higher rate of hypertension （70 vs. 51%, P 〈0. 05）. There were no significant differences in the prevalence rates of dyslipidemia,diabetes and number of risk factors between groups. M group showsa higher mean of serum triglycerides [ （2. 0 ±1.4） mmol/L vs. （ 1.6 ±0. 9） mmol/L, P 〈0. 05 ] and lower serum high-density lipoprotein cholesterol （HDL） cholesterol levels [ （ 1.03 ± 0. 23 ） mmol/L vs. （ 1.18 ± 0. 27） retool/L, P 〈 0. 01 ], lower apolipoprotein A [ （ 1.11 ± 0. 19） g/L vs. （ 1.20 ±0. 23 ） g/L, P 〈 0. 01 ], and apolipoprotein A/B ratio [ （ 1.4±0O. 5 ） vs. （ 1.6 ±0. 5 ）, P 〈 0. 01 ] than the F group. Traditional cardiovascular risk factor clustering in the M group is higher than in the F group [ （ 1.9 ± 1. 0） vs. （1.1 ± 0. 8）, P 〈0. 01]. Laborers were the most common occupation in the two groups （50 vs. 40% ） ; whereas the F group had a higher proportion of unemployment （12% vs. 30%, P 〈0. 01）. Absence of chest pain was noted commonly in the two groups （ 35 vs. 46% ） but without differences between groups. Palpitations were the most frequent symptom in the F group （7 vs. 22%, P 〈 0. 01 ） ; however, the phenomenon of perspiration appeared more frequently in the M group （44 vs. 29%, P 〈 0. 05）. Two groups showed no significant differences in angiographic findings in terms of the number of involved branches, severity of coronary lesion and ratio of patients who underwent PCI. CONCLUSION Some differences exist in clinical characteristics between female and male patients with premature coro- nary heart disease. Both sexes showed no significant differences in angiographic findings.