年轻急性心肌梗死患者临床及冠状动脉病变特征分析

目的 探讨年轻急性心肌梗死（AMI）患者临床及冠状动脉病变特征.方法 从我院2005年1月至2010年9月期间收治的AMI患者中,选取年龄＜40岁有完整冠脉造影资料的AMI患者48例作为年轻组,选取同期年龄＞60岁有完整冠脉造影资料的AMI患者52例作为对照组.比较两组的临床资料及冠脉造影结果.结果 两组患者均为男性占优势,而年轻组这一优势更加显著（91.7%比57.7%,P＜0.05）.年轻组中有冠心病家族史、长期大量吸烟、肥胖、血脂异常及ST段抬高型心肌梗死（STEMI）的比例均高于对照组（分别为27.1%比 9.2%,81.3%比 40.4%,47.9%比26.9%,29.2%比19.2%,89.6%比65.4%,P均＜0.05）,而高血压、糖尿病、既往劳累性心绞痛及非ST段抬高型心肌梗死（NSTEMI）的比例均低于对照组（分别为33.3%比51.9%,16.7%比32.7%,12.5%比38.5%,10.4%比34.6%,P值均＜0.05）.年轻组TG高于对照组（179.6±32.5）mg/dl比（138.5±27.3） mg/dl,P＜0.05],HDL-C低于对照组（36.7±16.8）mg/dl比 （43.2±13.7）mg/dl,P＜0.05],而TC及LDL-C均与对照组相当分别为（191.9±45.3）mg/dl比（187.4±42.8）mg/dl,P＞0.05;（118.4±30.5）mg/dl比（115.7±36.6）mg/dl,P＞0.05].年轻组中就诊时有典型胸痛的比例高于对照组（70.8%比28.8%,P＜0.05）.年轻组罪犯血管在左主干者占2.1%,前降支者占56.3%,回旋支者为8.3%,右冠状动脉者占33.3%,和对照组相比,差异无统计学意义.年轻组单支血管病变所占比例明显高于对照组（56.3%比26.9%,P＜0.05）,而多支血管病变所占比例明显低于对照组（37.3%比71.2%,P＜0.05）.结论 长期大量吸烟、冠心病家族史、肥胖、血脂异常是年轻人患AMI的主要危险因素.年轻AMI患者发病时症状典型,多表现为STEMI,且多为单支血管病变.

The clinical characteristics and coronary angiographic features in young patients with acute myocardial infarction

Objective To investigate the clinical characteristics and coronary angiographic features in young patients with acute myocardial infarction（AMI ）. Methods Data of patients with AMI admitted to our hospi- tal from January of 2005 to September of 2010 were collected. 48 consecutive patients〈40 years of age who were performed coronary angiography, and were assigned to the young group, 52 consecutive patients〉60 years of age who were performed coronary angiography during the same time as the control group. Clinical data and results of coronary angiography were collected and compared between the two groups. Results Both groups were predominantly male, but the young patients were more be male than the old patients （91.7% vs 57.7%, P〈0.05 ）. Also, the young patients were more smoke heavily （81.3% vs 40.4%, P〈0.05）, more obese （47.9% vs 26.9%, P〈0.05）, more dyslipidemia （29.2% vs 19.2%, P〈0.05）, more have family history （27.1% vs 19.2%, P〈0.05）, and more have STEMI compared with the old patients. The young patients had higher triglyceride levels （179.6± 32.5）mg/dl vs （138.5±27.3）mg/dl, P〈0.05 ], and lower high-density lipoprotein cholesterol levels （36.7±16.8） mg/dl vs （43.2±13.7）mg/dl, P〈0.05 ] than the old patients. The prevalence of hypertension （33.3% vs 51.9%, P〈0.05）, diabetes mellitus（16.7% vs 32.7%, P〈0.05）, and previous cardiac angina（ 12.5% vs 38.5%, P〈0.05） were significantly lower in the young patients than the old patients. More patients felt chest pain in the young group than the old group when AMI came on（70.8% vs 28.8%, P〈0.05）. As culprit artery, the prevalence of left main, left anterior descending coronary artery, left circumflex coronary artery and right coronary artery in the young pa- tients were 2.1%, 56.3%, 8.3%, and 33.3% vs 1.9%, 51.9%, 9.6% and 36.5% in the old patients, respective- ly. There was no difference between the two groups. The percentage of single-branch lesion was higher in the young patients （56.3% vs 26.9%, P〈O.05） and multi-branch lesion was significantly high in the old patients （37.3% vs 71.2%, P〈0.05）. Conclusion Heavy smoking, obesity, dyslipidemia and positive family history are the most important risk factors in young patients with AMI, and most of them have typical symptoms and have single-branch lesion.