不同性别早发急性心肌梗死患者危险因素及冠状动脉病变特点

Sexual differences in risk factors and coronary lesion characteristics of early onset acute myocardial infarction

目的探讨早发急性心肌梗死(AMI)患者的危险因素和冠状动脉病变特点的性别差异。方法收集2015年1月至2016年12月首都医科大学附属北京地坛医院经急诊冠状动脉造影诊断为早发AMI的129例患者的临床资料。其中男性组99例、女性组30例。比较2组患者的临床资料及冠状动脉病变情况等,评价其是否存在差异性。结果2组体重指数、高血压病史比例差异无统计学意义(P>0.05)。男性组患者年龄、2型糖尿病病史比例、脑卒中史比例低于女性组,吸烟史比例高于女性组,差异均有统计学意义(均P<0.05)。男性组高密度脂蛋白胆固醇、载脂蛋白A1水平低于女性组,低密度脂蛋白胆固醇升高比例、同型半胱氨酸水平高于女性组,差异均有统计学意义(均P<0.05)。2组患者罪犯血管位置差异无统计学意义(P>0.05)。男性组(97例行冠状动脉造影)冠状动脉3支病变及弥漫性病变比例低于女性组[27.8%(27/97)比63.3%(19/30)、46.4%(45/97)比73.3%(22/30)],差异均有统计学意义(均P<0.05)。结论糖尿病病史、脑卒中病史、载脂蛋白A1升高是女性早发AMI患者的主要危险因素,而吸烟史、同型半胱氨酸升高、低密度脂蛋白胆固醇升高是男性早发AMI患者的主要危险因素。女性患者3支病变及弥漫性病变比例高于男性患者。

Objective To investigate the differences of risk factors and coronary lesion characteristics between genders in patients with early onset acute myocardial infarction. Methods Clinical data of 129 patients with early onset acute myocardial infarction diagnosed by emergency coronary angiography in Beijing Ditan Hospital,Capital Medical University from January 2015 to December 2016 were collected. Among them,99 cases were male and 30 cases were female. Clinical data and characteristics of coronary artery lesions were analyzed between genders. Results There were no significant differences of body mass index and hypertension history between male and female groups( P > 0. 05). Age,ratios of type 2 diabetes history and stroke history in male group were lower and the ratio of smoking history was higher than those in female group( all P < 0. 05). Levels of high density lipoprotein cholesterol and apolipoprotein A1 in male group were lower,the ratio of low density lipoprotein cholesterol increasing and the level of homocysteine were higher than those in female group( all P <0. 05). There was no significant difference of the location of culprit vessel between groups( P > 0. 05). Ratios of three coronary artery lesions and diffuse lesions in male group( n = 97) were significantly lower than those in female group[27. 8%( 27/97) vs 63. 3%( 19/30),46. 4%( 45/97) vs 73. 3%( 22/30)]( both P < 0. 05).Conclusions Histories of diabetes and cerebral stroke and elevated level of apolipoprotein A1 are major risk factors of early onset acute myocardial infarction in women;smoking history,elevated levels of homocysteine and low density lipoprotein cholesterol are major risk factors in men. Ratios of three-vessel lesions and diffuse lesions in women are higher than those in men.