青岛急性心肌梗死患者危险因素及冠脉病变的地域性特点

Regional characteristics of risk factors and coronary artery lesions in patients with acute myocardial infarction in Qingdao

目的分析冠心病高发的青岛地区不同性别和年龄段急性心肌梗死(AMI)患者危险因素及冠脉病变的地域性特点,为针对性预防提供理论依据。方法回顾性分析青岛大学附属医院2017年1月至2017年10月收治的1 050例AMI患者的临床资料。根据性别将患者分为男性组(683例)和女性组(367例),根据年龄分为<50岁组(124例)、50~59岁组(199例)、60~69岁组(330例)、≥70岁(397例)。分析其危险因素和冠脉病变特点。结果男性AMI患者年龄为(62.01±12.35)岁,女性为(71.43±9.75)岁,男性AMI患者年龄低于女性,差异有统计学意义(P<0.01)。随年龄增长,AMI患者中女性比例逐渐提高,吸烟者的比例和患者的体质量指数(BMI)呈下降趋势。男性合并高血压病的比例高于女性(54.9%比46.1%,P<0.01)。随年龄增长,患者合并高血压病史的比例先升后降,比例最高的是60~69岁组[62.4%(206/330)]。男性合并糖尿病的比例低于女性(23.9%比40.3%,P<0.01)。合并糖尿病的比例随年龄增长而升高。60~69岁组和≥70岁组中,男性中糖尿病患者的比例均低于女性(均P<0.05)。50~59岁的女性ST段抬高型心肌梗死(STEMI)患者中,合并糖尿病者比例高达55.6%(5/9)。男性患者血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平均低于女性(均P<0.05)。随年龄增长,患者血清甘油三酯(TG)水平逐渐降低,HDL-C水平逐渐升高(均P<0.01)。共793例患者接受冠状动脉造影检查,结果显示,病变血管支数随年龄增长而增加,<50岁的AMI患者单支血管病变比例高达50.9%(57/112),左前降支是各年龄段患者最常见的病变部位。结论青岛地区AMI患者危险因素及冠脉病变存在独特的地域性特点:合并高血压病患者的比例随年龄增长先升后降;合并糖尿病的比例随年龄增长而升高,50~59岁女性STEMI患者超过一半合并糖尿病;50岁以下单支血管病变比例大于50%。

Objective To analyze regional characteristics of the risk factors and coronary artery lesions in patients with acute myocardial infarction(AMI)of different genders and ages in Qingdao,and provide a theoretical basis for targeted prevention.Methods The clinical data of 1 050 patients with AMI admitted to the Affiliated Hospital of Qingdao University from January 2017 to October 2017 were retrospectively analyzed.Patients were divided into male group(683 cases)and female group(367 cases)according to gender.According to age,they were divided into<50 years old group(124 cases),50-59 years old group(199 cases),60-69 years old group(330 cases),and≥70 years old(397 cases).The risk factors and characteristics of coronary lesions were analyzed.Results The age of male patients with AMI was(62.01±12.35)years old,and that of females was(71.43±9.75)years old.The age of male AMI patients was lower than that of females,and the difference was statistically significant(P<0.01).With the increase of age,the proportion of women in AMI patients gradually increased,and the proportion of smokers and the body mass index(BMI)of patients decreased.The proportion of male patients with hypertension was higher than that of women(54.9%vs.46.1%,P<0.01).With the increase of age,the proportion of patients with hypertension increased first and then decreased,and the highest proportion was 60-69 years old group(62.4%(206/330))The proportion of men with diabetes was lower than that of women(23.9%vs.40.3%,P<0.01).The proportion of diabetic patients increased with age.In 60-69 years old group and≥70 years old group,the proportions of male patients with diabetes were both lower than that of females(both P<0.05).Among women with ST-segment elevation myocardial infarction(STEMI)in 60-69 years old group,the proportion of patients with diabetes was as high as 55.6%(5/9).The serum levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)in male patients were lower than those in females(all P<0.05).With the increase of age,the serum triglyceride(TG)level decreased gradually,and the HDL-C level gradually increased(both P<0.01).A total of 793 patients underwent coronary angiography.The results showed that the number of diseased vessels increased with age.The proportion of single vessel disease in AMI patients<50 years old was as high as 50.9%(57/112).The left anterior descending branch was the most common lesion in patients of all ages.Conclusion There are unique regional characteristics of risk factors and coronary lesions in patients with AMI in Qingdao.The proportion of hypertensive patients increases first and then decreases with age.The proportion of patients with diabetes increases with age,and more than half of STEMI patients in women aged 50-59 have diabetes.The proportion of single vessel disease in patients under 50 years old is greater than 50%.