40岁及以下女性冠心病患者临床特点和危险因素分析

目的探讨年轻冠心病患者的临床特点及性别差异。方法回顾分析2009—2013年在我院诊断为冠心病并行冠状动脉造影检查,年龄≤40岁的女性患者,共77例,并以年龄按1:4随机匹配308例男性患者。对入选患者的临床表现、危险因素、冠状动脉造影特点和治疗方法进行比较分析。结果 (1)临床表现:女性患者自发/变异型心绞痛比例显著高于男性(14.3%比7.1%,P=0.045),心肌梗死比例显著低于男性(35.1%比58.1%,P<0.001);(2)危险因素:女性患者吸烟比例显著低于男性(5.2%比79.9%,P<0.001);高血压、2型糖尿病、血脂异常、阳性家族史比例性别差异无统计学意义(均为P>0.05);(3)冠状动脉造影结果:女性患者的零支病变、单支病变、双支病变和三支/左主干病变的比例和男性比较,总体差异无统计学意义;但女性零支病变比例高于男性(9.1%比3.2%,P=0.026);(4)治疗方法:女性患者单纯药物治疗比例高于男性(33.8%比16.2%,P<0.001),经皮冠状动脉介入治疗术比例低于男性(64.9%比79.5%,P=0.007)。结论年轻冠心病患者女性吸烟比例低于男性,自发/变异型心绞痛、非阻塞性冠状动脉病变和接受单纯药物治疗者更多。

Clinical characters and risk factors of young female patients with coronary artery disease

Objective To explore the clinical characters of young patients with coronary artery disease （CAD）. Methods A total of 77 young （ ≤40 years） female patients who were diagnosed CAD and conducted with coronary angiography （CAG） were enrolled, with 308 young male patients as comparison, during the period of 2009 to 2013 in Fuwai Hospital. Clinical manifestations, risk factors, CAG results and treatments were analyzed. Results （ 1 ） Women were more likely to have spontaneous/variant angina （14. 3% vs. 7.1% , P =0. 045） but less likely to have myocardial infarction （35.1% vs. 58.1% , P 〈 0. 001 ） compared with men. （2） Cigarette smoking was less prevalent in women than in men （5.2% vs. 79. 9% , P 〈 0. 001 ）. The prevalence of other risk factors, including hypertension, diabetes, hyperlipidemia and positive family history was similar in women and men. （ 3 ） Generally the severity of coronary lesions wasn＇t different between women and men. But women had bigger proportion of zero-vessel lesion than men （9. 1% vs. 3.2% , P =0. 026）. （4）More female patients were treated just with medication （33.8% vs. 16. 2%, P〈0.001）, but less to accept PCI （64,9% vs. 79. 5%, P=0.007） compared with men. Conclusions Except for smoking, the other traditional risk factors play a similar role in young female CAD patients as in male, spontaneous/variant angina, non-occlusive coronary lesions and single drug treatment are more common in female.