早发冠心病急性ST段抬高型心肌梗死患者冠脉病变特点及危险因素分析

Characteristics of coronary artery lesions and risk factors in patients with premature acute ST segment elevation myocardial infarction

目的分析早发冠心病急性ST段抬高型心肌梗死(STEMI)患者冠脉病变特点及危险因素,为预防早发STEMI提供理论依据。方法回顾性研究2018年11月至2021年6月来滕州市中心人民医院胸痛中心就诊的402例患者的临床资料和冠脉造影结果,对早发STEMI(男性<55岁,女性<65岁,124例,男94例、女30例)和晚发STEMI患者(278例,男214例、女64例)传统及非传统危险因素、冠脉病变特点进行统计学分析。统计学方法采用t检验、χ^(2)检验、非参数检验。结果早发STEMI组体质量指数、肥胖、冠心病家族史比例高于晚发组,差异均有统计学意义(t=2.417、χ^(2)=3.987、11.355,均P<0.05),高血压病史比例低于晚发组(χ^(2)=7.277,P<0.05);早发STEMI组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、载脂蛋白B(apoB)、血尿酸(UA)高于晚发STEMI组(t=4.796、4.170、5.210、4.900、3.239,均P<0.05),HDL-C、Hcy低于晚发STEMI组(t=3.369、Z=3.271,均P<0.05);早发STEMI组长病变比例低于晚发组,支架植入数量、支架直径与晚发组比较,差异均有统计学意义(χ^(2)=4.389、t=2.534、Z=2.008,均P<0.05);logistic回归分析显示:LDL-C(OR=2.174,95%CI 1.123~4.209)、TG(OR=1.476,95%CI 1.161~1.877)、UA(OR=1.005,95%CI 1.002~1.007)、冠心病家族史(OR=6.102,95%CI 2.859~13.030),均是早发STEMI独立危险因素(均P<0.05),HDL(OR=0.27,95%CI 0.099~0.734,P<0.05)是早发STEMI保护因素。结论LDL-C、TG、UA、冠心病家族史是早发STEMI独立危险因素,目前早发STEMI发病呈现年龄更加年轻化,冠脉病变程度加重化趋势,需要我们更加重视,加强健康生活方式的宣传,积极纠正可逆的危险因素,做好冠心病的一级预防。

Objective To analyze the characteristics coronary artery lesions and risk factors in patients with premature acute ST segment elevation myocardial infarction(STEMI)and to provide theoretical basis for the prevention of early onset STEMI.Methods The clinical data and coronary angiography data of the 402 patients treated at Chest Pain Center,Tengzhou Central People's Hospital from November 2018 to June 2021 were retrospectively studied.The traditional and non-traditional risk factors and the characteristics of coronary lesions in the 124 patients with early onset STEMI,including 94 men who were<55 years old and 30 women who were<65 years old and the 278 patients with late onset STEMI,including 214 men and 64 women,were statistically analyzed.t test,χ^(2) test,and non-parametric test were applied.Results The body mass index and proportions of the patients with obesity and family history of coronary heart disease in the early onset STEMI group were significantly higher than those in the late onset STEMI group(t=2.417;χ^(2)=3.987 and 11.355;all P<0.05);the proportion of the patients with hypertension family history in the early onset STEMI group was significantly lower than that in the late onset STEMI group(χ^(2)=7.277,P<0.05).The levels of total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),triglyceride(TG),apolipoprotein B(apoB),and uric acid(UA level)in the early onset STEMI group were significantly higher than those in the late onset STEMI group(t=4.796,4.170,5.210,4.900,and 3.239;all P<0.05);the levels of high-density lipoprotein cholesterol(HDL-C)and homocysteine(Hcy)in the early onset STEMI group were significantly lower than those in the late onset STEMI group(t=3.369;Z=3.271;both P<0.05).The proportion of long lesion and the number and the diameter of stents implanted at the lesion sites of the patients in the early onset STEMI group were significantly lower than those in the late onset STEMI group,with statistical differences(χ^(2)=4.389;t=2.534;Z=2.008;all P<0.05).Logistic regression analysis showed that the LDL-C(OR=2.174,95%CI 1.123-4.209),TG(OR=1.476,95%CI 1.161-1.877),UA(OR=1.005,95%CI 1.002-1.007),and family history of coronary heart disease(OR=6.102,95%CI 2.859-13.030)were the independent risk factors of early onset STEMI(all P<0.05),while the HDL(OR=0.27,95%CI 0.099-0.734,P<0.001)was the protective factor.Conclusions LDL-C,TG,UA,and family history of coronary heart disease are independent risk factors of early onset STEMI.The incidence of early onset STEMI is currently starting earlier and the severity of coronary artery disease is aggravating.More attention must be paid to enhance the dissemination of healthy lifestyle and actively correct the reversible risk factors to facilitate the primary prevention of coronary heart disease.