绝经前女性急性心肌梗死患者临床特点分析

Clinical characteristics of premenopausal women with acute myocardial infarction

目的分析绝经前后女性急性心肌梗死患者的危险因素、临床症状和冠状动脉病变特点，探讨绝经前女性心肌梗死的临床特点。方法选取2014年1月~2016年1月因急性心肌梗死收住北京市门头沟区医院心内科且行冠状动脉造影确诊的女性患者218例，其中绝经前患者56例，绝经后患者162例，另选取同期因胸痛人院的冠状动脉造影正常的绝经前女性65例，比较分析三组患者间的危险因素、临床症状及冠状动脉病变特点。结果绝经前急性心肌梗死组与绝经前冠状动脉正常组比较：高血压、糖尿病、血脂异常、高尿酸血症、早发冠心病家族史、吸烟史及典型胸痛症状比例均显著增高（P<0.05);绝经前急性心肌梗死组与绝经后急性心肌梗死组比较：高血压、糖尿病、血脂异常及高尿酸血症的发生率显著降低（P<0.05),典型胸痛症状比例显著增高（P<0.05),单支病变的发生率显著增高（P<0.01),三支病变的发生率显著降低（P<0.01),前降支病变的发生率显著增高（P<0.01)。结论高血压、糖尿病、血脂异常、高尿酸血症、早发冠心病家族史及吸烟史为绝经前女性急性心肌梗死的重要危险因素，发病时有典型的胸痛症状，冠状动脉病变以单支病变多见，前降支是最易累及的血管。

Objective To analyze the risk factors,clinical symptoms and characteristics of coronary arterylesions in premenopausal and postmenopausal women with acute myocardial infarction,and to explore the clinicalcharacteristics of premenopausal women with myocardial infarction.Methods A total of218female patients withacute myocardial infarction adm itted to the Departm ent of Cardiology of Mentougou D istrict Hospital in Beijingfrom January2014to January2016diagnosed by coronary angiography were selected,including56premenopausalpatients and162postmenopausal patients.In addition,65premenopausal females with normal coronary angiographywere enrolled in this study.The risk factors,clinical symptoms and coronary artery lesions were compared betweenthe three groups.Results Com pared with prem enopausal patients w ithout acute m yocardial infarction,theprem enopausal patients showed high rates of hypertension,diabetes,dyslipidemia,hyperuricem ia,family historyof early coronary artery disease,smoking and typical stethalgia(P<0.05).Compared with postm enopausalpatients,the prem enopausal patients had low incidences of hypertension,diabetes,dyslipidem ia,hyperuricem ia(P<0.05)and triple vessel d ise ase(P<0.01),but high rates of typical stethalgia(P<0.05),single vesseldisease(P<0.01)and anterior descending artery disease(P<0.01).Conclusion H ypertension,diabetes,dyslipidemia,hyperuricemia,family history of early coronary artery disease and smoking were indicated to be risksof premenopausal acute myocardial infarction.Stethalgia was one of the typical clinical signs.Single vessel diseasewas more frequent in coronary artery lesions.Anterior descending artery was apt to be involved in the case.