青年人急性心肌梗死危险因素及冠状动脉病变特点

目的: 探讨青年人急性心肌梗死的危险因素及冠状动脉病变特点。方法: 将48例年龄 ≤ 40岁的急性心肌梗死患者列为青年组,50例年龄> 40岁的急性心肌梗死患者列为中老年组,比较并分析2组冠心病危险因素及冠状动脉病变特点。结果: 青年组患者男性心肌梗死发生率为97.97%,高于中老年组的82.00%(P < 0.05);青年组患者高血压发生率为19.00%,明显低于中老年组的60.00%(P < 0.01);青年组无"三高"(糖尿病、高血压、血脂异常)比例(67.00%)患者高于中老年组(30.00%)(P < 0.01)。青年组以吸烟为唯一危险因素患者比例高达52.00%,而中老年组只有6.00%。青年组无"三高"无吸烟者其他危险因素:早发心血管家族史3例,多动脉栓塞(高凝状态)1例,2例不明。中老年组无"三高"无吸烟者其他危险因素:3例高龄(男> 55岁,女> 65岁),早发心血管家族史1例,1例不明。与中老年组比较,青年组患者单支冠状动脉病变率高(P < 0.01),多支冠状动脉病变率低(P < 0.01)。结论: 青年人心肌梗死大部分为男性,多无"三高"危险因素,吸烟常为唯一危险因素,无"三高"、无吸烟者常有早发心血管家族史。与中老年心肌梗死患者相比,青年人心肌梗死者冠状动脉单支病变率较高。

Risk factors for acute myocardial infarction in the youth and the coronary angiographic findings

Objective：To investigate the risk factors and the coronary angiographic findings in young adults with acute myocardial infarction（AMI）.Methods：The AMI patients under the age of 40 were defined as youth group（n=48） and those above 40 as mid-elderly group（n=50）.The clinical data（risk factors and coronary angiographic findings） of both groups were collected and compared.Results：The incidence of AMI was 97.97% in the male patients in the youth group,while it was 82.00% in the mid-elderly group（P〈0.05）.The youth group had a lower proportion of hypertension（19.00% vs 60.00%,P〈0.01）,and a higher proportion of non-＂three highs＂（hypertension,diabetes mellitus,dyslipidemia）（67.00% vs 30.00%,P〈0.01） as compared with the mid-elderly group.The proportion of patients with smoking as the only risk factor accounted for 52.00% in the youth group,while it was only 6.00% in the mid-elderly group.Among the six AMI cases with no ＂three highs＂ or smoking history in the youth group,3 were proved to have a family history of early-attacking cardiovascular disease,1 had atheroembolism and 2 had unknown reasons.The youth group had a higher proportion of single coronary artery lesions（46.00% vs 20.00%,P〈0.01） and lower proportion of multiple branch lesions（52.00% vs 78.00%,P〈0.01） than the mid-elderly group.Conclusions：Most of the young AMI patients are male,presenting no ＂three highs＂;smoking is usually the only risk factor.And the young patients who do not have ＂three highs＂ or smoke usually have a family history of early-attacking cardiovascular disease.Compared with the mid-elderly,most of the young AMI patients suffer from single coronary vessel disease.