未绝经女性患者冠状动脉事件临床特点分析

目的 分析未绝经女性患者冠状动脉事件的临床特点.方法 回顾性分析1995-2007年间于北京协和医院接受诊治的未绝经女性冠心病患者47例,已绝经女性冠心病患者172例和未绝经非动脉粥样硬化性冠状动脉疾病女性患者(non-AS CAD组)18例的临床表现.结果 (1)与已绝经冠心病组比较:未绝经冠心病组的高血压、糖尿病、高脂血症的发生率较低(均P<0.01),既往发生胸痛较少(14.9%比82.6%,P<0.01),冠心病危险因素个数较少(1.04±0.98比2.21±0.10,P<0.01),急性冠状动脉综合征(ACS)较多(83.0%比48.8%,P<0.01);冠状动脉造影显示以单支病变为主(70.2%比29.1%,P<0.01),冠状动脉病变积分(Gensini评分)较低(10.5±7.2比56.5+27.0,P<0.01);logstic回归发现,肥胖是未绝经女性冠心病患者独立的危险因素(OR =3.655,95%CI:1.15～11.59,P=0.028).(2)18例non-AS CAD患者占疑诊冠心病未绝经女性患者中的28%,其中16例以ACS起病.与未绝经冠心病组比较,血生化指标、危险因素、冠状动脉病变情况等差异均无统计学意义.结论 未绝经女性冠心病患者较已绝经女性冠心病患者合并高血压、糖尿病、高脂血症者少,冠心病危险因素少;既往发生胸痛较少,以ACS起病多见;肥胖是独立的危险因素.非动脉粥样硬化性冠状动脉疾病也是引起未绝经女性患者发生冠状动脉事件的重要原因.

Clinical manifestations of premenopausal women with coronary arterial disease

Objective To compare clinical characteristics among premenopansal women with coronary arterial disease(CAD)with or without atherosclerosis(AS)and postmenopausal women with CAD.Methods The clinical and coronary angiographic data,traditional risk factors(age,smoking,blood pressure,lipid profile,blood glucose,BMI,family history)were compared among premenopause(Pre-M,n=42)and post-menopause(Post-M,n=172)women with CAD as well as Pre-M patients with non-AS CAD(non-AS CAD,n=18).Results Compared with the Post-M patients with CAD,Pre-M CAD patients had significantly fewer traditional risk factors,such as hypertension,diabetes and hypercholesterolemia,significantly more acute coronary syndrome and fewer previous history of chest pain,significantly more single vessel lesion and lower Gessini score(all P<0.01).The logistic regression results showed that obesity is an independent risk factor for the development of CAD in premenopausal women(OR=3.655,95%CI:1.15-11.59,P=0.028).Hypertension(OR=4.73,95%CI:0.991-22.589,P=0.051)and hypercholesterolemia(OR=4.68,95%CI:0.971-22.564.P=0.055)might also contribute to the development of CAD in these patients. Clinical characteristics were similar between Pre-M and non-AS CAD Patients(P>0.05).Conclusions Pre-M CAD patients had less traditional risk factors and lower coronary lesion score compared to post-M CAD patients. Obesity is an independent risk factor for Pre-M CAD. Non-AS coronary artery disease is also an important reason for the development of coronary arterial events in premenopausal women.