绝经前心肌梗死女性冠心病危险因素分析

Analysis of cardiac risk factors in premenopausal women with acute myocardial infarction

目的分析绝经前女性急性心肌梗死相关临床特点和发病危险因素,为临床诊治提供一定的思路。方法回顾性分析2009年1月至2019年11月北京大学第一医院心内科住院的确诊为急性心肌梗死的18~50岁绝经前女性患者58例(其中青年女性组患者20例,中年女性组患者38例),同期匹配男性患者116例。比较不同组间临床特点,logistic单因素及多因素分析采用二元回归分析发病危险因素。结果女性组患者合并高血压病38例(65.5%)、男性组患者69例(59.5%);女性组患者合并糖尿病21例(36.2%),男性组患者37例(31.9%)。女性组患者典型胸痛发作(69.0%比83.6%,P=0.026)、既往心绞痛发作(31.0%比62.1%,P<0.001)、ST段抬高型心肌梗死(41.4%比66.4%,P=0.002)、吸烟(13.8%比83.6%,P<0.001)、脂代谢紊乱的比例(36.2%比70.7%,P<0.001)及体重指数(BMI)[(24.14±3.48)kg/m2比(25.87±2.99)kg/m2,P=0.001]、血清肌酐[69.5(45.0,874.0)μmol/L比87.0(50.0,1487.0)μmol/L,P<0.001]、三酰甘油[1.45(0.43,11.65)mmol/L比1.81(0.55,6.02)mmol/L,P=0.035]水平均显著低于男性组患者,但慢性肾病比例(22.4%比6.9%,P=0.003)及心肌梗死后左心室射血分数<50%比例(37.9%比20.7%,P=0.015)均显著高于男性组患者,差异均有统计学意义。青年女性组患者慢性肾病比例(40.0%比13.2%,P=0.043)、血液透析比例(35.0%比10.5%,P=0.042)及收缩压[(151.40±25.43)mmHg(1 mmHg=1.33 kPa)比(133.55±30.01)mmHg,P=0.032]、舒张压[(91.90±16.96)mmHg比(80.66±18.91)mmHg,P=0.034]均显著多于中年女性组患者,差异均有统计学意义。将不同性别比较的logistic多因素回归分析显示,年龄(OR 0.902,95%CI 0.831~0.980,P=0.015)、既往心绞痛(OR 2.770,95%CI 1.138~7.751,P=0.026)、吸烟(OR 36.201,95%CI 12.495~104.883,P<0.001)、脂代谢紊乱(OR 4.988,95%CI 1.844~13.493,P=0.002)和慢性肾病(OR 0.220,95%CI 0.056~0.868,P=0.031)与冠心病危险因素相关。logistic多因素回归分析结果显示,青年组与中年组女性患者4个指标(慢性肾病、血液透析、入院查体收缩压及舒张压)均未显示与冠心病危险因素相关。结论绝经前发生心肌梗死的女性中慢性肾病的发病率高。慢性肾病是重要的冠心病危险因素。在患有慢性肾病的中青年女性患者中,应重视冠心病的预防工作。

Objective To investigate clinical characteristics and risk factors in premenopausal women with acute myocardial infarction and provide some ideas for clinical diagnosis and treatment.Methods From January 2009 to November 2019,premenopausal women under the age of 50 with acute myocardial infarction hospitalized in Peking University First Hospital and according to the proportion of 1:2 matched the male patients with acute myocardial infarction were enrolled,the clinical features an risk factors of patients with different sexes were compared.Then we divided the female into 2 groups:the young group(age≤45) and the middle-age group(age> 45 and≤50),and also analyzed the differences of clinical characteristics and risk factors.Results A total of 58 females and 116 males were selected.Compared with male patients,female patients presented with more atypical symptoms(69.0% vs.83.6%,P=0.026) and fewer previous angina attacks(31% vs.62.1%,P<0.001).Left ventricular ejection fraction was significantly lower in women after acute myocardial infarction than in men(37.9% vs.20.7%,P=0.001).The proportion of women with stage 4-5 chronic kidney disease was significantly higher than that of men,disordered lipid metabolism and smoking history was lower than that of men.Multivariate Logistic regression analysis showed age(95%CI 0.831-0.980,P=0.015),smoking(95%CI12.495-104.883,P<0.001),dyslipidemia(95%CI 1.844-13.493,P=0.002),and stage 4-5 chronic kidney disease(95%CI 0.056-0.868,P=0.031) were independently associated with gender.Conclusions The prevalence of chronic kidney disease is high among premenopausal women with myocardial infarction,which is an important risk factor for coronary heart disease.Among young and middle-aged women with chronic kidney disease,attention should be paid to the prevention of coronary heart disease.