中青年女性发生急性ST段抬高型心肌梗死的危险因素分析

摘要

目的 分析中青年女性发生急性ST段抬高型心肌梗死(STEMI)的危险因素.方法 收集2014年1月至2015年1月在首都医科大学附属北京安贞医院确诊为急性STEMI的18～ 50岁女性患者50例作为观察组,同时以同期在我院经冠状动脉造影证实冠状动脉正常的同年龄段女性患者150例作为对照组.记录和比较2组患者的临床资料,包括年龄、血压、心率、高血压病史、糖尿病史、高脂血症病史、吸烟史、血清尿酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C).采用单因素和多因素Logistic回归方法分析中青年女性患者发生STEMI的危险因素.结果 观察组患者心率、血清尿酸和三酰甘油水平明显高于对照组[(75±12)次/min比(69±11)次/min、300(256,380) mmol/L比268(221,302) mmol/L、1.5(1.1,2.0) mmol/L比1.3(0.8,1.7) mmol/L],HDL-C水平明显低于对照组[(1.01 ±0.21) mmol/L比(1.16 ±0.26) mmol/L],高血压病史、糖尿病史、高脂血症病史比例明显高于对照组[54.0％(27/50)比36.7％(55/150)、34.0％(17/50)比8.7％(13/150)、70.0％ (35/50)比53.3％(80/150)],差异均有统计学意义(均P＜0.05).单因素Logistic回归分析显示,影响中青年女性发生急性STEMI的危险因素有心率、高血压病史、糖尿病史、高脂血症病史、血清尿酸水平及HDL-C水平(均P＜0.05).多因素Logistic回归分析显示,患者高心率(比值比=1.043,95％置信区间:1.004～ 1.084,P=0.029)、糖尿病史(比值比=3.342,95％置信区间:1.340 ～8.338,P=0.010)、高血清尿酸水平(比值比=1.006,95％置信区间:1.001～ 1.011,P=0.015)是预测中青年女性发生急性STEMI的独立危险因素,而高HDL-C水平(比值比=0.114,95％置信区间:0.016 ～ 0.807,P=0.030)为其独立保护因素.结论 高心率、糖尿病史及高血清尿酸水平都是预测中青年女性发生急性STEMI的独立危险因素,而高HDL-C水平为其独立保护因素.%Objective To analyze risk factors of acute ST-segment elevation myocardial infarction (STEMI) in young and middle-aged women.Methods Fifty women(18-50 years old) with acute STEMI from January 2014 to January 2015 in Beijing Anzhen Hospital,Capital Medical University were enrolled as observation group.One hundred and fifty same age healthy women were enrolled as control group.Age,blood pressure,heart rate,hypertension history,diabetes history,hyperlipidemia history,smoking history,serum levels of uric acid,total cholesterol,triacylglycerol,low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol(HDL-C) were analyzed.Results Heart rate,serum uric acid and triacylglycerol in observation group were significantly higher than those in control group [(75 ± 12)times/min vs (69 ± 11)times/rin,300(256,380) mmol/L vs 268(221,302) mmol/L,1.5 (1.1,2.0) mmol/L vs 1.3 (0.8,1.7) mmol/L] (P ＜ 0.05),HDL-C in observation group was significantly lower than that in control group[(1.01 ± 0.21) mmol/L vs (1.16 ± 0.26) mmol/L] (P ＜ 0.05);histories of hypertension,diabetes,hyperlipidemia in observation group were significantly higher than those in control group[54.0％ (27/50) vs 36.7％ (55/150),34.0％ (17/50) vs 8.7％ (13/150),70.0％ (35/50) vs 53.3％ (80/150)] (P ＜ 0.05).Univariate logistic regression analysis showed that heart rate,histories of hypertension,diabetes,hyperlipidemia,serum uric acid and HDL-C were risk factors of acute STEMI (P ＜ 0.05).Multivariate logistic regression analysis showed that heart rate [odds ratio (OR) =1.043,95％ confidence interval (CI):1.004-1.084,P =0.029],history of diabetes (OR =3.342,95％ CI:1.340-8.338,P =0.010) and serum uric acid(OR =1.006,95％ CI:1.001-1.011,P =0.015) were independent risk factors of acute STEMI;HDL-C was an independent protective factor of acute STEMI (OR =0.114,95％ CI:0.016-0.807,P =0.030).Conclusions High heart rate,history of hypertension and high serum level of uric acid are independent risk factors of acute STEMI in young and middle-aged women;high serum level of HDL-C is an independent protective factor of acute STEMI.