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中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 87 -94. doi: 10.3877/cma.j.issn.1674-0785.2019.02.002

所属专题: 文献

临床研究

不同性别和年龄急性心肌梗死患者的相关危险因素及冠状动脉病变特点
孙瑞聪1, 褚现明2,(), 于海初1, 廉哲勋1, 徐庆科1, 李冰3   
  1. 1. 266000 青岛大学附属医院心内科
    2. 青岛大学附属心血管病医院心内科
    3. 青岛大学基础医学院遗传与细胞生物学系
  • 收稿日期:2018-09-21 出版日期:2019-01-15
  • 通信作者: 褚现明
  • 基金资助:
    国家自然科学基金面上项目(81471546); 山东省医药卫生科技发展计划项目(2014WS017); 山东省高校科技计划项目(J18KA285)

Risk factors and characteristics of coronary lesions in patients with acute myocardial infarction of different gender andage

Ruicong Sun1, Xianming Chu2,(), Haichu Yu1, Zhexun Lian1, Qingke Xu1, Bing Li3   

  1. 1. Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
    2. Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China; Department of Cardiology, the Affiliated Cardiovascular Hospital of Qingdao University, Qingdao 266000, China
    3. Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, China
  • Received:2018-09-21 Published:2019-01-15
  • Corresponding author: Xianming Chu
  • About author:
    Corresponding author: Chu Xianming, Email:
引用本文:

孙瑞聪, 褚现明, 于海初, 廉哲勋, 徐庆科, 李冰. 不同性别和年龄急性心肌梗死患者的相关危险因素及冠状动脉病变特点[J/OL]. 中华临床医师杂志(电子版), 2019, 13(02): 87-94.

Ruicong Sun, Xianming Chu, Haichu Yu, Zhexun Lian, Qingke Xu, Bing Li. Risk factors and characteristics of coronary lesions in patients with acute myocardial infarction of different gender andage[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(02): 87-94.

目的

分析不同性别和年龄的急性心肌梗死(AMI)患者的危险因素及冠状动脉病变的特点,为针对性预防提供理论依据。

方法

选取2017年1~10月青岛大学附属医院收治的AMI患者1050例,男性683例,女性367例,<50岁患者124例、50~59岁患者199例、60~69岁患者330例、≥70岁患者397例。分析不同年龄和性别患者的危险因素和冠状动脉病变特点。

结果

男性AMI患者平均发病年龄低于女性[(62.01±12.35)岁 vs (71.43±9.75)岁,P<0.01];随年龄增长,吸烟患者的比例和患者的体质量指数均呈下降趋势,而女性患者的比例逐渐增加;患者合并高血压病的比例随年龄增加呈先升后降的趋势,比例最高的是60~69岁年龄组(62.4%),男性患者合并高血压病的比例高于女性(54.9% vs 46.1%,P<0.05);合并糖尿病的比例随年龄增加而升高,60岁以后各年龄段女性合并糖尿病的比例均较男性偏高(40.0% vs 27.3%,42.6% vs 26.4%,P均<0.05),尤其ST段抬高型心肌梗死患者中,女性合并糖尿病的比例在50~59岁组最高达55.6%;随年龄的增长,患者血清三酰甘油水平逐渐降低,高密度脂蛋白胆固醇逐渐升高;冠状动脉造影结果显示,AMI患者病变血管支数随年龄的增长而增加,<50岁的患者单支血管病变比例高达50.9%,<50岁的患者以左前降支病变最为常见,> 70岁的患者以左前降支、右冠状动脉病变多见。

结论

针对不同性别和年龄的AMI患者可采取差异化的防治措施。

Objective

To analyze the regional characteristics of risk factors and coronary artery lesions in patients with acute myocardial infarction (AMI) of different genders and age groups in Qingdao, where there is a high incidence of coronary heart disease.

Methods

From January to October 2017, 1050 AMI patients admitted to the Affiliated Hospital of Qingdao University were divided into male (n=683) and female (n=367) groups,<50 years old (n=124 cases), 50-59 years old (n=199 cases), 60-69 years old (n=330 cases), and≥70 years old (n=397 cases) group according to gender and age. The risk factors and characteristics as well as coronary lesions were analyzed.

Results

The average age of onset of male AMI patients was significantly lower than that of females [(62.01±12.35) years old vs (71.43±9.75) years old, P<0.01). With the increase of age, the proportion of smoking patients and the body mass index (BMI) of patients showed a downward trend, while the proportion of female patients gradually increased. The proportion of patients with hypertension increased first and then decreased with age, with the highest proportion observed in the 60-69 age group (62.4%). The proportion of male patients with hypertension was higher than that of females (54.9% vs 46.1%, P<0.05). The proportion of patients with diabetes increased with age, and after the age of 60, the proportion of women with diabetes in all ages is higher than that of men (40.0% vs 27.3%, 42.6% vs 26.4%, P<0.05 of all), especially in patients with ST-segment elevation myocardial infarction; the proportion of women with diabetes was up to 55.6% in the 50-59 age group. With the increase of age, triacylglycerol (TG) levels gradually decreased, and high-density lipoprotein (HDL-C) levels gradually increased. Coronary angiography results showed that the number of vascular lesions in patients with AMI increased with age. In patients aged<50 years, the single vessel lesion rate was as high as 50.9%; patients aged<50 years were most commonly diagnosed with LAD lesions; in patients aged>70 years, LAD and right coronary artery (RCA) lesions were more common.

Conclusion

Different prevention and treatment measures can be taben for AMI patients of different gender and age.

表1 不同性别急性心肌梗死患者危险因素特点比较
表2 不同年龄组急性心肌梗死患者危险因素特点比较
表3 不同年龄组男性急性心肌梗死患者危险因素特点比较
表4 不同年龄组女性急性心肌梗死患者危险因素特点比较
表5 不同年龄组急性心肌梗死患者危险因素的性别差异
组别 例数 年龄(岁) BMI(kg/m2 STEMI[例(%)] 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
<50岁 117 43.6±4.8 27.0±3.9 61(52.1) 82(70.1) 48(41.0) 17(14.5) 2.2±1.7 4.6±1.4 1.1±0.3 2.7±1.1
7 46.5±1.7 25.4±2.4 5(71.4) 0(0) 4(57.1) 2(28.6) 1.6±1.2 3.9±0.8 1.1±0.3 2.2±0.7
统计值 ? ? t=-3.726 t=1.118 χ2=0.365 χ2=7.877 χ2=0.198 χ2=0.213 t=0.931 t=1.408 t=-0.477 t=1.287
P ? ? <0.05 0.266 0.546 <0.05 0.656 0.644 0.354 0.162 0.634 0.200
组别 ? 例数 年龄(岁) BMI(kg/m2 STEMI[例(%)] 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
50~59岁 168 54.5±2.6 26.1±2.8 74(44.0) 105(62.5) 93(55.4) 39(23.2) 1.8±1.2 4.5±1.1 1.1±0.3 2.7±0.8
31 56.0±2.7 26.1±3.7 9(29.0) 5(16.1) 18(58.1) 9(29.0) 2.1±2.3 5.1±1.5 1.3±0.2 2.9±1.3
统计值 ? ? t=-2.912 t=0.034 χ2=2.427 χ2=20.926 χ2=0.078 χ2=0.484 t=-1.171 t=-.862 t=-2.804 t=-0.848
P ? ? <0.05 0.973 0.119 <0.05 0.780 0.487 0.243 0.071 <0.01 0.402
组别 ? 例数 年龄(岁) BMI(kg/m2 STEMI[例(%)] 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
60~69岁 205 64.6±2.9 25.2±3.2 89(43.4) 157(76.6) 118(57.6) 56(27.3) 1.7±1.3 4.4±1.1 1.1±0.3 2.6±0.8
125 64.9±2.9 25.0±3.6 40(32.0) 7(5.6) 88(70.4) 50(40.0) 1.7±0.9 4.7±1.1 1.2±0.3 2.8±0.8
统计值 ? ? t=-0.661 t=0.574 χ2=4.249 χ2=153.69 χ2=5.457 χ2=5.729 t=0.164 t=-2.441 t=-2.414 t=-1.652
P ? ? 0.509 0.566 <0.05 <0.05 <0.05 <0.05 0.87 <0.05 <0.05 0.099
组别 ? 例数 年龄(岁) BMI(kg/m2 STEMI[例(%)] 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
≥70岁 193 76.9±5.4 24.5±3.6 91(47.2) 105(54.4) 116(60.1) 51(26.4) 1.3±0.8 4.3±1.1 1.1±0.3 2.5±0.9
204 78.7±5.4 25.4±8.2 76(37.3) 10(49.0) 59(28.9) 87(42.6) 1.7±1.5 4.9±1.3 1.2±0.3 2.8±0.9
统计值 ? ? t=-3.342 t=-1.426 χ2=3.985 χ2=115.715 χ2=43.260 χ2=11.508 t=-3.831 t=-4.604 t=-4.536 t=-3.117
P ? ? <0.05 0.155 <0.05 <0.05 <0.05 <0.05 <0.01 <0.01 <0.01 <0.05
表6 不同年龄组ST段抬高型心肌梗死患者危险因素的性别差异
组别 例数 年龄(岁) BMI(kg/m2 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
<50岁 61 43.7±4.7 26.4±3.6 25(41.0) 25(41.0) 6(9.8) 2.0±1.6 4.7±1.5 1.1±0.3 2.8±1.2
5 46.2±1.9 25.0±2.7 0(0) 2(40.0) 2(40.0) 2.0±1.2 3.9±0.9 1.2±0.3 2.2±0.9
统计值 ? ? t=-2.422 t=0.883 χ2=3.299 χ2=0.002 χ2=1.623 t=0.062 t=1.109 t=-0.674 t=1.123
P ? ? <0.05 0.380 <0.01 0.966 0.203 0.951 0.272 0.503 0.266
组别 ? 例数 年龄(岁) BMI(kg/m2 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
50~59岁 77 54.2±2.5 26.3±2.9 47(61.0) 43(55.8) 14(18.2) 1.8±1.1 4.7±1.0 1.1±0.2 2.8±0.8
9 56.0±2.7 24.2±2.9 0(0) 6(66.7) 5(55.6) 1.7±0.7 5.2±1.8 1.3±0.1 3.1±1.2
统计值 ? ? t=-2.048 t=2.114 χ2=9.776 χ2=0.070 χ2=6.539 t=0.245 t=-0.951 t=-4.622 t=-0.631
P ? ? <0.05 <0.05 <0.01 0.791 <0.05 0.807 0.368 <0.01 0.544
组别 ? 例数 年龄(岁) BMI(kg/m2 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
60~69岁 89 64.6±2.9 25.3±3.2 66(74.2) 49(55.1) 17(19.1) 1.5±0.7 4.5±1.1 1.2±0.2 2.7±0.9
40 65.3±2.9 24.3±4.0 3(7.5) 27(67.5) 13(32.5) 1.4±0.7 4.8±1.1 1.3±0.4 2.9±0.9
统计值 ? ? t=-1.264 t=1.503 χ2=46.644 χ2=1.765 χ2=2.776 t=0.567 t=-1.320 t=-2.293 t=-1.086
P ? ? 0.209 0.135 <0.01 0.184 0.096 0.571 0.189 <0.05 0.280
组别 ? 例数 年龄(岁) BMI(kg/m2 吸烟史[例(%)] 高血压病史[例(%)] 糖尿病史[例(%)] TG(mmol/L) TC(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L)
≥70岁 91 76.4±5.2 24.6±3.8 54(59.3) 53(58.2) 19(20.9) 1.3±1.0 4.2±1.0 1.1±0.3 2.5±0.7
76 78.6±4.9 25.1±4.0 5(6.6) 58(76.3) 34(44.7) 1.7±1.3 4.8±1.3 1.1±0.3 2.8±0.9
统计值 ? ? t=-2.764 t=-0.959 χ2=48.176 χ2=6.070 χ2=9.807 t=-2.074 t=-3.014 t=-1.751 t=-2.429
P ? ? <0.01 0.339 <0.01 <0.05 <0.01 <0.05 <0.01 0.082 <0.05
表7 不同年龄组急性心肌梗死患者冠状动脉病变特点[例(%)]
表8 不同性别、年龄组急性心肌梗死患者冠状动脉病变特点比较[例(%)]
组别 例数 LAD LCX RCA 0支病变 单支病变 双支病变 三支病变
<50岁 107 56(52.3) 45(42.1) 42(39.3) 14(13.1) 54(50.5) 28(26.2) 11(10.3)
5 4(80.0) 2(40.0) 2(40.0) 1(20.0) 2(40.0) 1(20.0) 1(20.0)
χ2 ? ? 0.568 0.080 0.210 0.197 0.209 0.095 0.472
P ? ? 0.451 0.927 0.647 0.520 1.000 1.000 0.493
组别 ? 例数 LAD LCX RCA 0支病变 单支病变 双支病变 三支病变
50~59岁 144 80(55.6) 62(43.1) 78(54.2) 12(8.3) 67(46.5) 41(28.5) 24(16.7)
24 13(54.2) 7(29.2) 9(37.5) 5(20.8) 11(45.8) 5(20.8) 3(12.5)
χ2 ? ? 2.312 5.044 6.863 1.112 1.351 2.043 0.558
P ? ? 0.128 0.025 0.009 0.292 0.245 0.153 0.455
组别 ? 例数 LAD LCX RCA 0支病变 单支病变 双支病变 三支病变
60~69岁 181 115(63.5) 87(48.1) 92(50.8) 13(7.2) 71(39.2) 67(37.0) 30(16.6)
98 64(65.3) 44(44.9) 48(49.0) 13(13.3) 36(36.7) 27(27.6) 22(22.4)
χ2 ? ? 0.087 0.256 0.087 2.784 0.167 2.550 1.447
P ? ? 0.768 0.613 0.768 0.095 0.683 0.110 0.229
组别 ? 例数 LAD LCX RCA 0支病变 单支病变 双支病变 三支病变
≥70岁 130 90(69.2) 76(58.5) 90(69.2) 8(6.2) 34(26.2) 46(35.4) 42(32.3)
104 76(73.1) 62(59.6) 65(62.5) 11(10.6) 19(18.3) 38(36.5) 36(34.6)
χ2 ? ? 0.415 0.032 1.170 1.515 2.050 0.033 0.138
P ? ? 0.520 0.858 0.279 0.218 0.152 0.855 0.710
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