中青年急性心肌梗死患者临床特征分析

Clinical Features of Middle-aged and Young Patients with Acute Myocardial Infarction

目的分析中青年急性心肌梗死患者(AMI)临床特征。方法选取2010—2013年南阳市第二人民医院收治的AMI患者407例,根据年龄分为中青年组91例(<60岁)和老年组316例(≥60岁),比较两组患者一般资料、心电图表现、冠状动脉造影及超声心动图检查结果、心功能Killip分级。结果两组患者性别比较,差异无统计学意义(P>0.05);老年组患者糖尿病、高血压发生率及有起病诱因者所占比例高于中青年组,首发表现为呼吸系统症状、肩背部疼痛、中枢神经系统症状、胃肠道症状及其他症状者所占比例高于中青年组,首发表现为胸痛、胸闷者所占比例低于中青年组,上消化道出血、休克、心力衰竭及心律失常发生率高于中青年组,急性脑血管意外发生率低于中青年组(P<0.05)。两组患者心房梗死、后壁梗死及前间壁梗死发生率比较,差异无统计学意义(P>0.05);老年组患者高侧壁梗死、下壁梗死及≥2个部位梗死、非ST段抬高发生率高于中青年组,右心室梗死、广泛前壁梗死发生率低于中青年组,差异均有统计学意义(P<0.05)。两组患者左主干病变发生率比较,差异无统计学意义(P>0.05);老年组患者前降支病变、回旋支病变、右冠状动脉病变及≥2支病变发生率高于中青年组,血管正常率低于中青年组(P<0.05)。两组患者左心房内径、左心室舒张期末径及室间隔厚度比较,差异无统计学意义(P>0.05);老年组患者左心室射血分数、左房室瓣口舒张早期峰值血流速度(E值)低于中青年组,左房室瓣口舒张晚期峰值血流速度(A值)高于中青年组,心功能Killip分级差于中青年组(P<0.05)。结论中青年AMI患者多存在起病诱因、首发表现较典型、冠状动脉病变严重程度较轻、心功能较好,应积极予以治疗以改善其预后。

Objective To analyze the clinical features of middle- aged and young patients with acute myocardial infarction. Methods A total of 407 patients with acute myocardial infarction were selected in the Second People＇ s Hospital of Nanyang from 2010 to 2013,and they were divided into A group（ lower than 60 years old,n = 91） and B group（ equal or over60 years old, n = 316） according to age. General information, electrocardiographic findings, coronary angiography results,echocardiography results and cardiac Killip grade were compared between the two groups. Results No statistically significant differences of gender was found between the two groups（ P〉 0. 05）; incidence of diabetes and hypertension, proportion of patients with precipitating factors of B group was statistically significantly higher than that of A group,respectively（ P〈 0. 05）;proportion of respiratory symptoms,humeral back pain,central nervous system symptoms,gastrointestinal symptoms and other symptoms performed as first manifestation of B group were statistically significantly higher than those of A group,while proportion of chest pain and chest distress performed as first manifestation of B group were statistically significantly lower than those of A group（ P 〈0. 05）; The incidence of upper gastrointestinal hemorrhage,shock,heart failure and arrhythmia of B group were statistically significantly higher than those of A group, while incidence of acute cerebrovascular accident of B group was statistically significantly lower than that of A group（ P 〈0. 05）. No statistically significant differences of atrial myocardial infarction,posterior myocardial infarction or anteroseptal myocardial infarction was found between the two groups（ P〉 0. 05）,while incidence of high lateral myocardial infarction,inferior myocardial infarction,equal or over 2 infarcted focus,non- ST-segment elevation of B group were statistically significantly higher than those of A group, while incidence of right ventricular infarction and extensive anterior myocardial infarction of B group were statistically significantly lower than those of A group（ P 〈0. 05）. No statistically significant differences of incidence of left main coronary artery lesion was found between the two groups（ P 〉0. 05）; incidence of anterior descending artery lesion,left circumflex artery lesion,right coronary artery lesion and equal or over 2 vessel lesions of B group were statistically significantly higher than those of A group,while proportion of normal vessels of B group was statistically significantly lower than that of A group（ P〈 0. 05）. No statistically significant differences of left atrial diameter,LVDD or IVST was found between the two groups（ P 〉0. 05）; LVEF and early diastolic blood flow peak velocity of left atrioventricular orifices of B group were statistically significantly lower than those of A group,while late diastolic blood flow peak velocity of left atrioventricular orifices of B group was statistically significantly higher than that of A group,and the cardiac Killip grade of B group was statistically significantly worse than that of A group（ P〈 0. 05）. Conclusion Most middle- aged and young patients with acute myocardial infarction exist precipitating factors,have typical first manifestation,and the severity of coronary artery lesions is relatively mild,the cardiac function is relatively good,that should be positively treat to improve the patients＇ prognosis.