高血压对青年女性心肌梗死患者的影响及其与冠状动脉病变的关系

摘要

目的 探讨高血压对青年女性急性心肌梗死的影响及其与冠状动脉病变程度的关系.方法 收集2003年6-12月在首都医科大学附属北京安贞医院及武装警察部队北京市总队医院住院诊断为急性心肌梗死并行冠状动脉造影的64例青年女性(年龄≤44岁)患者的临床资料进行回顾性分析,根据冠状动脉造影结果,分为单支病变患者(46例)和多支病变患者(18例);选取同时期住院行冠状动脉造影排除冠心病诊断的青年女性60例作为对照组.观察高血压与冠状动脉病变程度在急性心肌梗死患者中的关系.结果 ①青年女性中,心肌梗死组高血压比例(56.2％,36/64)高于对照组(8.3％,5/60),多支病变患者高血压比例(77.8％,14/18)高于单支病变患者(47.8％,22/46) (P ＜0.05).②Logistic回归分析显示,青年女性患者中,高血压[比值比(OR)=16.173,95％置信区间(CI):4.130 ～ 63.328]、血红蛋白(OR=1.039,95％ CI:1.002 ～1.078)及尿酸(OR=1.008,95％ CI:1.001 ～ 1.016)是急性心肌梗死的独立危险因素(均P＜0.05).③心肌梗死组中,高血压合并冠状动脉多支病变患者(38.9％,14/36)多于非高血压合并多支病变患者(14.3％,4/28) (P＜0.05);急性ST段抬高型心肌梗死患者中,高血压合并冠状动脉多支病变(77.8％,14/18)的比例高于单支病变组(46.2％,18/39) (P ＜0.05).结论 高血压是青年女性急性心肌梗死的独立危险因素,合并高血压的心肌梗死患者冠状动脉病变更为严重.%Objective To investigate the characteristics of hypertension and the relation between hypertension and the severity of coronary artery lesions in young women with acute myocardial infarction (AMI).Methods We retrospectively studied 64 young women with acute myocardial infarction.All patients were admitted to hospital from Jun.2003 to Dec.2013 and undergone coronary angiography; the clinic and coronary angiographic features were assessed.According to the result of coronary angiography,the patients were divided into two groups:the single-vessel-lesion and the multiple-vessel-lesion.The relation among hypertension and acute myocardial infarction and severity of coronary artery disease were observed.Results ①The ratio of patients with hypertension in AMI group was significantly higher than in non-CHD group[56.2％ (36/64) vs 8.3％ (5/60),P ＜0.05].In AMI patients,the ratio of patients with hypertension in the single-vessel-lesion group was significantly lower than in the multiple-vessel-lesion group [47.8 ％ (22/46) vs 77.8 ％ (14/18),P ＜ 0.05].②Applying Logistic regression analysis,hypertension(OR =16.173,95％ CI:4.130-63.328),hemoglobin (OR =1.039,95％ CI:1.002-1.078) and uric acid (OR =1.008,95％ CI:1.001-1.016) were independent risk factors(P ＜ 0.05) for young women with AMI.③In AMI patients,the ratio of patients with hypertension in the multiple-vessel-lesion group was significantly higher than that in patients without hypertension in the multiple-vessel-lesion group [38.9％ (14/36)vs 14.3％ (4/28),P ＜ 0.05].In ST-segment elevation myocardial infarction patients,the ratio of patients with hypertension in the single-vessel-lesion group was significantly lower than in the multiple-vessel-lesion group [46.2％ (18/39) vs 77.8％ (14/18),P ＜ 0.05].Conclusion Hypertension is a risk factor for young women with AMI,and coronary artery lesions are more severe in hypertension patients with AMI.