青年急性心肌梗死危险因素及冠状动脉病变特点分析

Analysis of the risk factors and the characteristics of coronary artery disease in young patients with acute myocardial infarction

目的探讨青年急性心肌梗死(AMI)的危险因素,并分析其冠状动脉病变特点,为青年AMI的防治提供临床依据。方法选择新乡医学院第一附属医院2014年1月至2017年11月收治的青年(≤45岁)AMI患者236例为AMI组,并选取同期青年健康人群300例为对照组,分析青年AMI的危险因素及冠状动脉病变特点。结果 236例青年AMI患者中,单支血管病变120例(50.85%),双支血管病变92例(38.98%),3支血管病变24例(10.17%);总病变血管支数376支,其中左冠状动脉前降支212支(56.38%),右冠状动脉108支(28.72%),左冠状动脉回旋支52支(13.83%),左冠状动脉主干4支(1.06%)。单因素分析结果显示,AMI组有心血管疾病家族史、吸烟史、饮酒史、高血压、糖尿病、血脂代谢异常、心理压力、过度劳累或熬夜的患者比例显著高于对照组(P<0.05),AMI组患者体质量指数(BMI)、总胆固醇(TC)、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)水平显著高于对照组(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平显著低于对照组(P<0.05)。Logistic回归分析结果显示,心血管疾病家族史、吸烟、饮酒、心理压力大、过度劳累或熬夜、高血压、糖尿病、BMI、血脂代谢异常(血TC、TG、LDL-C、HDL-C水平异常)是青年AMI的独立危险因素(P<0.05)。结论青年AMI患者冠状动脉病变以单支血管病变、左冠状动脉前降支病变最为常见,青年AMI发生的危险因素较多,应针对各项危险因素制定有效的防范措施,以降低青年AMI发病率。

Objective To investigate the risk factors for acute myocardial infarction(AMI),and to analyze the characteristics of coronary artery disease and provide clinical basis for the prevention and treatment of young patients with AMI.Methods A total of 236 young patients(≤45 years old)with AMI in the First Affiliated Hospital of Xinxiang Medical University from January 2014 to November 2017 were selected as AMI group,and 300 healthy young subjects were selected as the control group.The risk factors and the characteristics of coronary artery disease in young patients with AMI were analyzed.Results Among the 236 young patients with AMI,there were 120 cases of single vessel disease(50.85%),92 cases(38.98%)of double vessel disease and 24 cases(10.17%)of three vascular lesions.There were 376 diseased vessels in the 236 cases of young AMI patients,including 212(56.38%)branches of the left anterior descending coronary artery,108(28.72%)branches of the right coronary artery,52(13.83%)branches of the ramus circumflexus arteriae coronaria sinistrae and 4(1.06%)branches of the left coronary artery main stem.Univariate analysis showed that the proportions of patients with family history of cardiovascular disease,smoking history,drinking history,hypertension,diabetes mellitus,dyslipidemia,psychological stress,overwork or stay up in the AMI group were significantly higher than that in the control group(P<0.05);and the body mass index(BMI),total cholesterol(TC),three acylglycerol(TG)and low density lipoprotein cholesterol(LDL-C)levels of patients in the AMI group were significantly higher than those in the control group(P<0.05),and the level of high-density lipoprotein cholesterol(HDL-C)was significantly lower than that in the control group(P<0.05).Logistic regression analysis showed that the family history of cardiovascular disease,smoking,alcohol drinking,psychological stress,overwork or stay up,hypertension,diabetes,BMI,abnormal lipid metabolism(TC,TG,LDL-C and HDL-C levels anomaly)were the independent risk factor for young AMI patients(P<0.05).Conclusions The most common coronary artery lesion in young AMI patients is single vessel disease and left anterior descending coronary artery disease.There are many risk factors for young AMI patients,and the effective preventive measures should be set up to reduce the incidence of AMI in young people.