男性和女性急性心肌梗死患者住院死亡率差异的原因探讨

目的：通过比较男性和女性急性心肌梗死（AMI）患者的临床特征及住院治疗，探讨不同性别住院死亡率差异的原因。方法：回顾性研究1994年1月至2004年12月在我院住院的1246例男性和537例女性AMI患者，对比不同性别患者的临床特征、住院治疗和预后的差异。结果：与男性相比，女性患者年龄大［(67.7±8.5)岁vs (60.4±11.6)岁, P＜0.001］，高血压和糖尿病患病率高（51.40% vs 39.25%，28.31% vs 14.69%，P均＜0.001），入院时血清总胆固醇＞4.68?mmol/L和心功能≥killipⅢ级者多（73.37% vs 57.22%，11.92% vs 5.22%，P均＜0.001）。男性和女性的心绞痛史（64.53% vs 66.85%，P＝0.344）、陈旧性心肌梗死史（8.91% vs 9.87%，P＝0.519）和冠心病家族史（22.98% vs 20.68%，P＝0.348）阳性率无显著性差异。男性患者多有吸烟和饮酒史（69.74% vs 14.71%，78.49% vs 24.77%，P均＜0.001）。女性患者急性期再灌注治疗率（22.16% vs 28.01%，P＝0.010）和住院期间β受体阻滞剂的使用率显著低于男性（64.43% vs 70.14%，P＝0.017）。女性患者住院死亡率高于男性（11.92% vs 6.90%，P＜0.001）。结论：女性AMI患者住院死亡率显著高于男性，造成这一差异的原因在于不同性别患者的临床特征和住院治疗不同，女性患者年龄大，伴随危险因素多，急性期再灌注治疗率和β受体阻滞剂的使用率亦显著低于男性。

Cause of the difference on in-hospital mortality between male and female patients with acute myocardial infarction——A single retrospective study from Qilu Hospital of Shandong University

December 2004. Variables including baseline characteristics, in hospital management and outcomes were recorded and compared between different gender groups. Results: Females were generally older than males (67.7±8.5 vs 60.4±11.6 years, P＜0.001) and had a higher prevalence of hypertension（51.40% vs 39.25%, P＜0.001）and diabetes mellitus（28.31% vs 14.69%, P＜0.001).The Killip class greater than or equal to Ⅲ（11.92% vs 5.22%，P＜0.001） and the total cholesterol (TC)＞4.68?mmol/L（73.37% vs 57.22%，P＜0.001）were more common in females. There was no significant difference on the history of previous angina pectoris, myocardial infarction and family coronary heart disease between males and females (64.53% vs 66.85%，P＝0.344；8.91% vs 9.87%，P＝0.519；22.98% vs 20.68%，P＝0.348, respectively）, however, the history of cigarette smoking（69.74% vs 14.71%, P＜0.001) and alcohol drinking（78.49% vs 24.77%，P＜0.001) was more common in males. Reperfusion therapy within the first 24 hours after symptom onset and β－blockers were underused during hospitalization phase in females compared with males (22.16% vs 28.01%, P＝0.010; 64.43% vs 70.14%, P＝0.017, respectively). An increased mortality was demonstrated in females during the hospitalization phase of AMI（11.92% vs 6.90%, P＜0.001). Conclusions: The in hospital mortality of females is higher than that of males following AMI. Females are older and have more risk factors than males, and reperfusion therapy and β blockers are underused, all of which are important causes of the difference on in hospital mortality between male and female patients with AMI.