青年人与老年人急性心肌梗死冠脉病变与临床的对比研究

目的：研究青年人急性心肌梗死（AMI）的临床及冠脉病变特点，探讨导致青年人AMI的可能因素，方法：对比分析AMI的危险因素，诱发因素，左室射分数，冠状动脉造影（CAG）结果，结果：45岁以下者29例（A组）与60岁以上者31例（B组）吸烟指数＞100者分别为72．4％，41．9％，饮酒指数＞150者分别为44．8％，16．1％，有冠心病阳性家族史者分别为41．3％，12．9％，有高血压史分别为20．7％，51．6％，（均P＜0．05），有明确诱因者分别为79．3％，33．3％（P＜0．01），冠状动脉造影冠脉正常，1支病变，双支病变，3支病变A组分别为24．1％，44．8％，10．3％，6．9％，B组分别为3．2％，16．9％，35．5％，45．2％，冠脉内有血栓者A，B组分别为27．6％，6．5％，左室射血分数（EF）＜50％者分别为13．8％，48．3％，结论：45岁以下AMI与吸烟，大量饮酒密切相关，其次为阳性家族史，其发病多有明确诱因，冠状动脉正常和单支病变较多，病变程度较轻，冠脉痉挛和血栓形成可能成为其重要原因。

Comparative Research of Coronary Arterial Pathological Changes and Clinical Features of Acute Myocardial Infarction in Young and Old

Objective:To research the coronary arterial pathological change clinical charactor of AMI in young group,discuss possible factors responsible for the occurence of AMI in these groups.Methods:Analyse the risk factor inducement,left ventricular efflux fraction(LVEF) and coronary angiography results.Results:Compared with that in patients 29 in A group younger than 45 and 31 in B group older than 60,the proportions of patients whose smoking index was more than 100(72.4% vs 41.9%),and drinking index was more than 150 (44.8% vs 16.1%),in AMI patients younger than 45(A group)obviously increased,which has significant statistical meaning(P<0.05).Furthermore,the proportions of patients with positive familial history.(41.3% vs 12.9%,P<0.05).Hypertension history(20.7% vs 51.6%,P<0.05)and definite inducement(79.3% vs 32.3% P<0.01) in A groups also increased.The positive rates of coronary angiography in two groups were respectively 24.1%,3.2%in which patients with a single branch stenosis occupied 44.8%,16.1%;patients with both branch stenosis occupied 10.3%,35.5%;while patients with three branch stenosis occupied 6.9%,45.2%.And 13.8% of patients in A group obtained EF less than 50% while 48.3% of patients in B group got the same EF extent. Conclusions:Occureace of AMI in patients younger than 45 year old closely associated with severe smoking and drinking.Most of these patients had defenite inducement.Their coronary arterial pathologocal changes were often slight,which mostly invaded only a single branch.Coronarospasm and thrombogenesis are possibly important cause.