50岁以下急性冠脉综合征女性患者危险因素及冠状动脉病变特点

Acute coronary syndrome in women below 50 years of age: risk factors and clinical and angiographic features

目的探讨年龄在50岁以下女性急性冠脉综合征(ACS)患者之危险因素、冠脉病变等特点。方法纳入年龄50岁以下女性ACS住院患者共131例作为疾病组,同期收治的年龄50岁以下冠脉造影正常的非冠心病住院患者共425例作为对照组,对比分析两组间冠心病危险因素、临床及冠脉造影特点。结果血脂异常者、高血压患者、糖尿病患者及冠心病阳性家族史者,疾病组明显多于对照组(P<0.05),而是否停经2组间差异无统计学意义(P>0.05)。疾病组患者舒张压值明显高于对照组(P<0.05)而停经年龄则差异无显著性。在已停经患者中,各项危险因素除冠心病阳性家族史外,疾病组与对照组差异无统计学意义(P>0.05)。总胆固醇、甘油三酯,疾病组明显高于对照组(P<0.05),而其他血脂成分(如低密度脂蛋白、高密度脂蛋白等)则差异无统计学意义(P>0.05)。尿蛋白阳性患者比例,疾病组明显高于对照组。疾病组中,单支冠脉病变者占54.2%;多支病变者29.8%;冠脉轻度狭窄或正常者占16.0%。受累的冠脉以左前降支及其分支最多。结论年龄50岁以下女性ACS患者,其危险因素主要为各种传统危险因素及尿蛋白阳性,单纯停经没有导致冠心病发病率的增加。相当部分这些患者冠脉病变仅轻度异常甚或未见异常。

Objective To investigate the risk factors and angiographic features of acute coronary syndrome（ACS） in women below 50 years of age. Methods A total of 131 women with ACS aged 50 years or younger were enrolled in this study as the case group, with another 425 women aged below 50 years with normal coronary angiographic findings as the control group.The risk factors and clinical and coronary angiographic features of ACS were analyzed. Results Compared with the control group, significantly higher frequencies of dyslipidemia, hypertension（especially diastolic hypertension）, diabetes, or a positive family history for coronary artery disease（CAD） were found in ACS group（P〈0.05）. The proportion of post- menopausal women and the menopausal ages were similar between the two groups（P〈0.05）, but the mean diastolic pressure was significantly higher in ACS group than in the control group（P〈0.05）. Among the menopausal women, the conventional risk factors for ACS were similar between the two groups with the exception of family history CAD, which was more frequent in ACS group. Serum total cholesterol and triglyceride levels were significantly higher in ACS group than in the control group（P〈0.05）, but the levels of high- and low-density lipoprotein cholesterol levels were comparable between them. Positive findings of urine protein were more frequent in ACS group. In ACS group, 54.2% of the patients had a single diseased artery, 29.6% had more than one diseased artery, and 16.0% had slightly diseased or even normal coronary arteries; the lesion was found most commonly in the left anterior descending artery. Conclusion In women with ACS below 50 years of age, the risk factors of ACS included the conventional risk factors of CAD and a positive finding of urine protein. Menopause is not associated with an increased incidence of ACS. A substantial portion of these ACS patients can have slightly diseased and even normal coronary arteries.