冠状动脉非阻塞性心肌梗死患者的临床及冠脉病变特点分析

Analysis of clinical features and coronary artery lesion characteristics in patients with myocardial infarction with non-obstructive coronary artery

目的:探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床特征、冠状动脉(冠脉)病变特点及危险因素。方法:回顾性分析2016年1月—2017年12月于上海交通大学医学院附属第九人民医院住院的AMI患者共476例,根据冠脉造影的结果分为MINOCA组(56例)和MICAD组(420例)。比较2组患者的临床特点、心脏结构、冠脉病变特征、危险因素等。结果:与MICAD组患者比较,MINOCA组患者的年龄较大(P<0.05)、男性较少(P<0.05),吸烟患者较少(P<0.05),非ST段抬高急性心肌梗死比例较低(P<0.05);空腹血糖、肌酸激酶、肌钙蛋白、白细胞计数、谷草转氨酶值、LDL-C值更低(P<0.05);β受体阻滞剂、他汀类药物的应用比例更低(P<0.05)。MINOCA组患者的多支病变比例显著低于MICAD组(P<0.05)。在心脏结构方面,MINOCA组和MICAD组差异无统计学意义。多因素logistic回归分析结果表明,吸烟和糖尿病是MINOCA的相关危险因素(P<0.05)。结论:与MICAD患者相比,MINOCA年龄偏大,女性较多,肌钙蛋白、LDL-C及白细胞计数明显更低。MINOCA的相关危险因素主要为糖尿病和吸烟。

Objective:To analyze the clinical characteristics,coronary artery lesion characteristics and risk factors in patients with myocardial infarction with non-obstructive(MINOCA).Methods:A total of 476 AMI patients were hospitalized in the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2017.They were divided into the MINOCA group(56 cases)and MICAD group(420 cases)according to the results of coronary angiography.The clinical characteristics,heart structure,coronary artery lesion characteristics,and risk factors of the two groups of patients were compared.Results:Compared with patients in the MICAD group,MINOCA group patients were older(P<0.05).Fewer men(P<0.05)and smokers(P<0.05)were found in the MINOCA group.The proportion of NSTEMI was lower(P<0.05);blood glucose,creatine kinase,troponin,white blood cell count,aspartate aminotransferase value,and LDL-C were lower(P<0.05).The proportion of beta-blockers and statins in the MICAD group was lower than that in the MICAD group(P<0.05).The number of coronary artery lesions in the MINOCA group was significantly lower than that in the MICAD group(P<0.05).There was no significant difference in cardiac structure between the MINOCA group and MICAD group.Multivariate logistic regression analysis showed that smoking and diabetes were related risk factors for MINOCA(P<0.05).Conclusion:Patients with MINOCA are older,more female,and had significantly lower troponin,LDL-C,and white blood cell counts.The main risk factors associated with MINOCA are diabetes and smoking.