40岁以下青年急性心肌梗死患者中家族性高胆固醇血症:检出率和临床特点

Familial hypercholesteremia in young patients under age of 40 with acute myocardial infarction:detection rate and clinical features

目的研究40岁以下急性心肌梗死(AMI)患者中家族性高胆固醇血症(FH)的检出率及临床特点。方法连续入组2012年1月1日至2015年8月31日于北京安贞医院确诊为AMI的患者678例,平均(35.5±4.2)岁,收集临床资料,根据荷兰临床脂质网络标准(DLCN)进行评分,分为可能FH组和非FH组。分析可能FH的检出率和临床特点。结果AMI中可能FH检出率为28.31%(192/678),确诊/很可能FH检出率为3.83%(26/678)。可能FH组发病年龄较早[(35.0±4.22)岁vs.(35.7±4.22)岁,P=0.076],心脑血管病家族史比例更高(P均<0.05),且多支病变发生率高(P<0.05)。无论是否经过降脂治疗,可能FH组LDL-C水平均高于非FH组(P<0.05)。结论40岁以下AMI患者中可能的FH比例更高,冠状动脉病变程度更严重。

Objective To study the detection rate and clinical features of familial hypercholesteremia(FH)in young patients under age of 40 with acute myocardial infarction(AMI).Methods AMI patients(n=678,average age=35.5±4.2)were chosen from Beijing Anzhen Hospital from Jan.1,2012 to Aug.31,2015.The clinical data was collected and scored according to the standard of Dutch Lipid Clinical Network(DLCN).The patients were divided in possible FH group and non-FH group.The detection rate and clinical features of possible FH were analyzed.Results The detection rate of possible FH was 28.31%(192/678)and detection rate of definite/probable FH was 3.83%(26/678)in AMI patients.The possible FH group had earlier onset age of AMI than non-FH group[(35.0±4.22)year-old vs.(35.7±4.22)year-old,P=0.076],and percentage of family history of cardiovascular disease was higher(all P<0.05)and incidence rate of multi-vessel lesions was higher(P<0.05)in possible FH group.The level of LDL-C was higher in possible FH group than that in non-FH group(P<0.05)whether the patients were treated with lipid-lowering therapy or not.Conclusion The percentage of possible FH incidence and coronary lesion severity are higher in AMI patients under age of 40.