年青女性冠心病危险因素和临床特点分析

目的：探讨绝经前年青女性冠心病患者的临床特点和危险因素。方法：选择2003—01／2007—01疑诊为冠心病而住院的绝经前女性患者86例，根据冠状动脉造影结果分为冠心病组和正常对照组，回顾性分析冠心病组的冠状动脉病变特点、临床特点及危险因素。结果：冠心病组40例，平均年龄（42．6±5．8）岁；对照组46例，平均年龄（43．8±4．6）岁。合并高血压、糖尿病、高脂血症的比例分别为67．5％vs13．0%、50．0％vs8．7％、55．0％vs13．0％，两组比较差异有统计学意义（P〈0．05）。总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）和脂蛋白aLp（a）]，两组比较差异有统计学意义（P〈0．05），而其他女性冠心病危险因素如冠心病家族史、吸烟无统计学意义（P〉0．05）。TC、LDL-C、Lp（a）在单支病变及多支病变两个亚组中，有统计学意义（P〈0．05）。冠心病组典型心绞痛多见（30／40例，75．0％vs4／46例，8．7％）（P〈0．05），特异性心电图变化均高于对照组（34／40例，85．0％vs15／46例，32．6％）（P〈0．05）。ST—T改变多见于冠心病组（26／34例76．5％vs3／15例20％）（P〈0．05），单独T波改变多见于对照组（8／34例，23．5％vs12／15例，80％）（P〈0．05）。冠脉病变以单支局限性狭窄多见，占80％，前降支最易受累。结论：高血压、糖尿病和（或）高脂血症为绝经前女性冠心病重要危险因素。冠状动脉病变程度与高脂血症密切相关。绝经前女性典型心绞痛伴ST—T改变应高度怀疑冠心病。冠脉病变以单支局限性病变多见，前降支最易受累。单独T波改变不能反映冠脉有无狭窄。

Analysis of Clinical Characteristics and Risk Factors in Premanopausal Women with Coronary Heart Disease

Objective：To study the clinical characteristics and risk factors in premanopausal women with coronary heart disease （CHD）. Methods ：Eighty six premanopausal female hospitalized patients with chest pain during 2003-01 2007-01 were classified in CHD group and contrast group by coronary angiography （CAG）. Risk factors,clinical symptoms and CAG characteristics were analyzed retrospectively. Results：40 cases in coronary group with average age 42.6± 5.8 years ,46 cases in contrast group with average age 43.8±4.6 years. The incidence of hypertension,diabetes and hyperlipidernia were significantly higher than that of contrast group （67. 5% vs 13. 0%, 50. 0% vs 8. 7%, 55.0% vs 13.0%）（P〈0. 05）. In TC,TG,HDL-C and Lp（a） , there were statistics differences between two groups （P〈0. 05） . No difference in CHD family history,smoking. In TC, LDL-C , Lp （a）, there were statistics differences between single vessel lesion and multi-vessel lesion （P〈0.05）. Typical angina pectoris and ECG changes were more common in CHD group （30/40 cases ,75% vs 4/46 cases,8.7%;34/40cases,85% vs15/46 cases , 32. 6 % ）. Single T-wave change was more common in contrast group （8/34 cases, 23.5 0% vs 12/15 cases, 80% ）. Single vessel localized lesion was common in CHD group. Left anterior disending artery was the most frequently involved vessel. Conclusion：Hypertension,diabetes and/or hyperlipidemia are major risk factors in premanopausal women with CHD. The extent of coronary artery lesion is closely related to hyperlipoidemia. Premanopausal women with typical angina pectoris and ST-T changes should be suspected CHD. Single vessel localized stenosis in LAD is typical lesions in CHD group. Single T-wave change don＇t reflect stenosis of coronary artery.