急性心肌梗死危险因素和促发因素的青年人与中老年人暴露率比较

目的结合新近发现的冠心病危险因素,总结青年人急性心肌梗死(AMI)的临床特点,探讨早发AMI的可能机制。方法回顾性对照分析青年组(≤40岁,37例)和中老年组(≥50岁, 105例)两组AMI患者与非冠心病患者的危险因素和促发因素的暴露率,并行冠脉造影检查。结果两组AMI患者危险因素分布存在差异,青年组表现为吸烟、血脂异常、家族史、C反应蛋白(CRP)、血浆纤维蛋白原(Fig)暴露率明显增多,中老年组为高血压、吸烟、血脂异常、糖尿病、CRP、Fig、同型半胱氨酸(P<0.05);青年组危险因素聚集率并不比中老年组高,但其发生AMI前多有明确的促发因素,且促发因素有聚集倾向,促发因素聚集与青年人AMI的发生存在明显剂量反应关系。结论青年人早发AMI可能与促发因素聚集有关,多种促发因素同时存在通过心肌缺血叠加效应导致动脉粥样硬化(As)患者和非As患者发生AMI。

Comparison of the expOSure rates of risk factors and inducing factors of acute myocardial infarction between younger aged adults

OBJECTIVE: To study the clinical characteristics of acute myocardial infarction (AMI) among younger adults and to explore the possible mechanisms of early myocardial infarction, combined with the newly discovered risk factors of coronary heart disease. METHODS: Data on comparative analysis to the exposure rates of the risk factors and inducing factors of non-CAD patients with two groups of AMI patients including younger adults group (< or =40 years old) and aged adults group (> or =50 years old). Coronary angiography was applied. RESULTS: There were differences noticed between the frequencies of risk factors of the two AMI groups. In younger adults group the exposure rates of smoking, hyperlipidemia, positive family history, C-reactive protein (CRP) and fibrinogen were markedly higher, while in elderly group the exposure rates of hypertension, smoking, hyperlipidemia, diabetes, CRP, fibrinogen and homocysteine (HCY) were markedly higher (P < 0.05). Although the clustering status of risk factors of the younger adult group was not higher than that of the elderly group. There were obvious inducing factors before the patients were attacked by AMI and the inducing factors inclined to cluster, which had obvious dose-reaction relationships with the occurrence of AMI in young people. CONCLUSION: Early AMI of younger adults might relate to the clustering status of inducing factors. The coexistence of several kinds of inducing factors was resulted in the occurrence of AMI of the atherosclerosis (As) and non-As patients by means of myocardial ischemia accumulation effect.