青年急性心肌梗死临床特点与冠状动脉造影分析

摘要

Objective To explore the features of the clinical and coronary angiography in the young patients (≤45 years)with acute myocardial infarction(AMI).Methods One hundred and two young AMI patients (≤45 years old,young group)and 100 elderly AMI patients (60-75 years old,elderly group)from the Department of Cardiology in the Second Hospital of Tianjin Medical University were enrolled in the study.The risk factors,induced factors,clinical manifestations,biochemical indicators,coronary angiography findings,complications and prognosis were analyzed in two groups.Results Male,smoking history,drinking history,family history of premature coronary heart disease, high triglyceride(TG),low high density lipoprotein cholesterol(HDL-C)and high uric acid(UA)were the risk factors in young group.The hypertension history,diabetes history,high fasting blood glucose were more common in elderly group.The young group had a clear incentive for 52.0%(53/102),elderly group had a clear incentive for 28.0%(28/100),the former was higher than that of the latter (P <0.01).The young group 85.3%(87/102),elderly group 78.0%(78/100)had typical angina pectoris,there were no significant differences between two groups.The chest tightness in young group 31.4%(32/102)appeared significantly higher than that of elderly group of 16.0%(16/100)( P <0.05).Coronary angiography showed there were no significant difference in infarction related artery,thrombus burden between two groups,but AMI in young group occurred in the anterior descending artery for 55.9%(57/102);single vessel disease and local lesions of AMI were more frequent in the young group(P <0.01);Gensini lesion score was lower(P < 0.05 ).Compared with the elderly group,the young group had fewer complications,especially arrhythmia and heart failure,and lower mortality in one week(P <0.01).Conclusion The main risk factors of AMI young patients were male,smoking,drinking,family history of premature coronary heart disease,high TG,low HDL-C and high UA.Tiredness and drinking were the main inducing factors.Single vessel disease,localized lesions were most common in young AMI patients,while their Gensini score,the complications and the mortality were lower or less.%目的：探讨青年（≤45岁）急性心肌梗死（AMI）患者的临床与冠状动脉造影特点。方法选择天津医科大学第二医院心脏科青年 AMI（≤45岁）患者102例（青年组），老年 AMI（60～75岁）患者100例（老年组），从危险因素、诱发因素、临床表现、生化指标、冠状动脉造影结果、并发症及预后方面进行比较。结果男性、吸烟史、饮酒史、早发冠心病家族史、高甘油三酯（TG）、低高密度脂蛋白胆固醇（HDL-C）以及高尿酸（UA）为青年组危险因素；老年组多存在高血压史和糖尿病史，空腹血糖水平高。青年组有明确诱因比例明显高于老年组52．0％（53/102）vs 28．0％（28/100）（P ＜0．01）；青年组发生典型心绞痛与老年组比较差异无统计学意义85．3％（87/102）vs 78．0％（78/100）；青年组出现胸闷明显高于老年组31．4％（32/102）vs 16．0％（16/100）（P ＜0．05）；冠状动脉造影显示两组罪犯血管分布和血栓负荷差异无统计学意义，但青年组 AMI 多发生于前降支55．9％（57/102）；青年组 AMI 单支病变、局限狭窄多见（P ＜0．01）；Gensini 病变积分低（P ＜0．05）；与老年组比较，青年组并发症少，尤其是心律失常，心力衰竭发生率低，1周内病死率低（P ＜0．01）。结论青年 AMI 的主要危险因素为男性、吸烟、饮酒、早发冠心病家族史、高 TG、高UA 及 HDL-C 降低，劳累和饮酒为主要诱发因素，单支、局限病变多见，Gensini 评分低，并发症少，病死率低。