老年女性心肌梗死患者的临床特点分析

Analysis of clinical features in elderly female patients with myocardial infarction

【目的】探讨老年女性心肌梗死发生的主要危险因素、临床特点,以期更好地对老年女性心肌梗死进行预防、诊断和治疗。【方法】本研究将我科于2013年1月1日至2017年12月31日之间收治的老年急性心肌梗死(acute myocardial infarction,AMI)患者768例纳入本研究,其中老年女性290例,老年男性478例。比较男女两组之间的临床特点,分析老年女性AMI患者的临床特征。【结果】与老年男性相比,女性平均年龄较大,合并糖尿病、高血压比例高,吸烟史、饮酒史较低(P<0.05)。在发生心肌梗死时,女性在总胆固醇、三酰甘油、低密度脂蛋白、纤维蛋白原、D-二聚体、碱性磷酸酶、淋巴细胞、左室射血分数较男性显著升高(P<0.05),谷草转氨酶、谷丙转氨酶、谷氨酰转肽酶、总胆红素、尿酸、肌酐、单核细胞显著降低(P<0.05)。多因素Logistic分析发现年龄、白蛋白、Killip分级是老年患在院期间预后的独立危险因素。性别分层分析显示:年龄(P=0.007)、白蛋白(P=0.004)、Killip分级(P=0.000)、左室射血分数(P=0.000)、白细胞(P=0.002)、单核细胞(P=0.018)是老年男性近期预后的独立影响因素,Killip分级(P=0.001)与尿酸(P=0.019)是老年女性近期预后的独立影响因素。【结论】老年女性AMI患者发病年龄较高、合并危险因素较多,年龄、白蛋白水平、Killip分级是老年AMI患者在院期间预后的独立危险因素。

【Objective】To investigate the main risk factors and clinical features of myocardial infarction in elderly female patients in order to better prevent,diagnose and treat myocardial infarction in elderly female patients.【Methods】A total of 768 elderly AMI patients who were admitted to our department from January 1,2013 to December 31,2017 were enrolled in the study.Among them,there were 290 elderly females and 478 elderly males.The clinical features were compared between male and female groups and the clinical features in elderly female AMI patients were analyzed.【Results】Compared with the elderly males,the average age of females was higher.There was a higher percentage in elderly female AMI patients who also suffered from diabetes and hypertension,and a lower percentage in smoking and alcohol drinking history(P<0.05).When myocardial infarction occurred,the total cholesterol,triglyceride,low-density lipoprotein,fibrinogen,D-dimer,alkaline phosphatase,lymphocytes and left ventricular ejection fraction in females were significantly higher than those in males(P<0.05).However,aspartate aminotransferase,alanine aminotransferase,glutamyl transpeptidase,total bilirubin,uric acid,creatinine and monocyte significantly decreased(P<0.05).Multivariate logistic analysis showed that age,albumin and Killip grading were independent risk factors for the prognosis of elderly patients in hospital.Gender stratification analysis showed that age(P=0.007),albumin(P=0.004),Killip grading(P=0.000),left ventricular ejection fraction(P=0.000),white blood cells(P=0.002)and monocytes(P=0.018)were the independent influencing factors for recent prognosis in elderly males.Killip grading(P=0.001)and uric acid(P=0.019)were independent risk factors for recent prognosis in elderly females.Multivariate logistic analysis found that age,albumin level and Killip grading were independent risk factors for the prognosis of elderly patients during the stay in hospital.【Conclusion】Elderly female AMI patients have a higher onset age and more combined risk factors.Age,albumin level and Killip grading are independent risk factors for the prognosis in elderly AMI patients in hospital.