不同年龄段急性心肌梗死病人临床特点分析

Age-related difference of clinical characteristics in patients with acute myocardial infarction

目的探讨不同年龄段急性心肌梗死病人的临床特点。方法入选2014年6月至2017年5月期间在西安医学院第二附属医院住院治疗的急性心肌梗死病人,共960例。根据年龄将病人分为4组:<55岁组(264例)、55~64岁组(300例)、65~74岁组(256例)、≥75岁组(140例)。查阅病历收集病人的临床资料,比较各组病人之间临床特点的差异。结果 (1)随着年龄的增加,女性急性心肌梗死病人的比例增加,而ST段抬高型心肌梗死的比例下降,不同年龄组之间差异均有统计学意义(P<0.05)。在冠心病传统危险因素方面,有吸烟史、血脂异常史和早发冠心病家族史病人的比例随着年龄增加而下降,合并高血压的比例随年龄增加而增加,各组之间差异均有统计学意义(P<0.05)。(2)急性心肌梗死病人的主要临床表现是持续性胸痛和大汗,分别占65.9%和64%。随着年龄的增加,持续前胸剧痛、大汗和放射痛的比例减低,各组之间的差异均有统计学意义(P<0.05)。结论随着年龄增加,急性心肌梗死发病的性别差异逐渐缩小,近半数≥75岁急性心肌梗死病人为女性。老年心肌梗死病人症状不典型,近半数≥75岁急性心肌梗死病人无持续性胸痛和大汗的典型症状。

Objective To analyze the age-related differences of clinical characteristics in the patients with acute myocardial infarction. Methods The patients with acute myocardial infarction（n =960） who were hospitalized in the Second Affiliated Hospital of Xi＇an Medical University from June 2014 to May 2017 were enrolled in this study. The patients were divided into〈 55 years old group（264 patients）,55-64 years old group（300 patients）,65-74 years old group（256 patients）,and ≥75 years old group（140 patients） according to age. The clinical data were collected and compared between the four groups. Results（1） The proportion of female patients with acute myocardial infarction increased with the increase of age,while the proportion of the patients with ST elevation myocardial infarction decreased with the increase of age,and there were significant differences between the groups（all P〈0. 05）. In terms of traditional risk factors of coronary heart disease,the proportion of patients with the history of smoking,dyslipidemia and family history of premature coronary heart diseases decreased,while the proportion of patients with hypertension increased with the increase of age. And there were significant differences between the groups（P 〈0. 05）.（2） Persistent chest pain and sweat were the major typical symptoms（65. 9% and 64%） in the whole cohort. The proportion of persistent chest pain,sweat and radiating pain decreased with the increase of age（all P 〈0. 05）. Conclusions With the increase of age,gender differences in the incidence rate of acute myocardial infarction is gradually reduced. Nearly half of patients in≥75 years old group are female. The atypical clinical symptoms often exist in elderly patients with acute myocardial infarction. Persistent chest pain and sweat are absent in nearly half of patients in≥75 years old group.