不同年龄段ST段抬高型心肌梗死男女患者院内病死率的性别差异

目的研究不同年龄段ST段抬高型心肌梗死(STEMI)患者不同性别院内病死率的差异。方法入选1994年1月1日至2006年12月31日首都医科大学宣武医院心脏科收治住院的STEMI患者1189例,其中男性869例,女性320例,年龄23~91岁。根据年龄分为3组:A组(65岁)571例;B组(65~74岁)419例;C组(≥75岁)199例。收集患者年龄、性别、2型糖尿病、血脂、血压等方面的临床资料。结果 A组中,与男性STEMI患者比较,女性(3.1%vs.8.3%)院内病死率升高,差异具有统计学意义(P0.05)。在B组中,与男性STEMI患者比较,女性院内病死率升高(11.9%vs.20.1%)。C组中,男性与女性STEMI患者病死率差异无统计学意义(P0.05)。三组中,随着年龄增长,女性对男性院内病死率的优势比(OR)亦呈逐步下降趋势(2.861 vs.1.875 vs.1.143)。通过多因素分析,校正混杂因素后,在A组,年龄(OR=1.154,95%CI:1.052~1.264),高血压(OR=7.685,95%CI:2.276~25.946)为STEMI患者院内病死的独立危险因素,急诊再灌注治疗(OR=7.685,95%CI:0.007~0.098)为STEMI患者院内病死的保护因素。在B组,女性(OR=1.875,95%CI:1.088~3.232)是STEMI患者院内病死的独立危险因素。结论女性STEMI患者院内病死率较男性高,年龄越大其差异越小。在65岁人群中,年龄,高血压为STEMI患者院内病死的危险因素,急诊再灌注治疗为保护因素;在65~74岁人群中,女性为STEMI患者院内病死的危险因素。

Gender Differences in in-hospital mortality between male and female patients with ST-segment elevation myocardial infarction

Objective To study the difference in in-hospital mortality between male and female patients with ST-segment elevation myocardial infarction （STEMI）. Methods The patients （n=1189） were chosen （including 869 male ones and 320 female ones, aged from 23 to 91） from Jan. 1, 1994 to Dec. 31, 2006. All patients were divided into group A （age＆lt;65, n=571）, group B （aged from 65 to 74, n=419） and group C （age≥75岁, n=199）. The clinical data of age, gender, type 2 diabetes mellitus （T2DM）, blood fat and blood pressure （BP） were collected from the patients. Results In group A, in-hospital mortality increased in female patients compared with that in male ones （3.1%vs. 8.3%, P＆lt;0.05）. In group B, in-hospital mortality increased in female patients compared with that in male ones （11.9%vs. 20.1%）. In group C, the difference in in-hospital mortality had no statistical significance between male and female patients （P〉0.05）. In 3 groups, the odds ratio （OR） of in-hospital mortality in female patients showed a descending trend （2.861 vs. 1.875 vs. 1.143） as age increasing. Multivariate analysis showed that, after adjusting confounders, age （OR=1.154, 95%CI：1.052-1.264） and hypertension （OR=7.685, 95%CI：2.276-25.946） were independent risk factors of in-hospital mortality, and emergency reperfusion treatment （OR=7.685, 95%CI：0.007-0.098） was protective factor in group A. In group B, female （OR=1.875, 95%CI： 1.088-3.232） was an independent risk factor of in-hospital mortality. Conclusion In-hospital mortality is higher in female patients that that in male ones, while the difference will decrease as age increases. In patients aged〈65, age and hypertension are risk factors of in-hospital mortality and emergency reperfusion treatment is protective factor. In Patients aged from 65 to 74, female is a risk factor of in-hospital mortality.