1903例疑诊冠心病患者临床及冠状动脉造影特点的性别差异

摘要

Objective Coronary heart disease in women is currently a hot point of research. The aim of this study is to figure out the major risk factors of coronary heart disease( CHD) as well as gender and aging differences in coronary angiography( CAG).Methods Five hundred and ninty-seven women with suspected CHD who were undergone CAG were divided into two groups( ＜ 60y and ≥60) . The clinical presentation, coronary angiograms and major cardiovascular risk factors were compared and analyzed with 1306 counterparts of men. Results The incidence of atypical chest pain in women was significantly higher than in men in comparable age groups ( 66. 7％ vs 45. 3％ , 58. 5％ vs 35. 1％ ,P ＜0. 01 ). The incidence of ST segement elevation myocardial infarction in youger women was significantly lower than that in comparable men( 7. 2％ vs 22.4％). The CAG positive rate was significantly lower in women than that in men (43. 6％ vs 64. 8％ and 69. 4％ vs 83. 2 ％ ,P ＜0. 01). The older cases are more likely to have angiographically multiple-vessels diseases. The incident of single-vessel disease in younger women was significantly higher than that in older women or comparable men( 67. 1％ vs 38. 4％ ;67. 1％ vs 43. 4％ ,P ＜0.01) . Gensini score was significantly lower in women than that in men in comparable age groups ( 25. 4 ± 24.2 vs 37. 7 ± 30. 6;39. 4 ± 34. 4 vs 48. 6 ± 38. 9 ,P ＜ 0. 01 ) . Incidences of involved coronary arteries were in a descending order for left anterior descending branch , right coronary artery ,left circumflex branch and left main coronary artery. The incidences of hypertension , diabetes mellitus and hyperlipemia was significantly higher in older women than those in comparahle men (68. 8％ vs 63. 7％ ,25. 5％ vs 19. 4% ,P ＜0.05 ;19.7％ vs 11. 8％ ,P ＜ 0. 01 ) . The incidence of smoking in men was significantly higher than that in women (70. 7％ vs 1. 2％ ;50. 5％ vS 3. 6％ ,P ＜ 0. 01 ) . Conclusion With the growth of age , the decline of estrogen significantly has become a risk factor for the progress of coronary artery lesion in women with coronary heart disease. The incidence of atypical chest pain in women was significantly higher than that in men. The CAG positive rate , incidence of multiple-vessels diseases and Gensini score were significantly lower in women than that in men. The incidences of hypertension, diabetes mellitus and hyperlipemia were significantly higher in older women than that in comparable men. However, the incidence of smoking in men was significantly higher than that in women.%目的 女性冠心病是近年来的研究热点之一.文中比较不同年龄段男、女性冠状动脉造影(coronary angiography,CAG)及冠心病主要危险因素的差异.方法 收集拟诊为冠心病行CAG检查的女性患者597例,分为中青年组(<60岁)和老年组(≥60岁),与同期进行CAG检查的男性患者1306例进行临床表现、冠状动脉病变特点及危险因素的对比分析.结果 女性各组不典型胸痛发生率均明显高于同龄男性各组(66.7%vs45.3%,58.5%vs35.1%),P<0.01;中青年女性ST段抬高性心肌梗死的发生率明显低于中青年男性各组(7.2%vs 22.4%),P<0.05;女性各组CAG阳性率均明显低于同龄男性各组(43.6%vs64.8%,69.4%vs83.2%),P<0.01;男、女性组内随年龄增长,多支病变率显著升高,其中女性中青年组以单支病变为主,明显高于老年女性及同龄男性各组(67.1%vs38.4%,67.1%vs43.4%),P<0.01.女性冠心病患者Gensini积分明显低于同龄男性各组(25.4±24.2vs37.7±30.6,39.4±34.4vs48.6±38.9),P<0.01.病变累及的血管依次为左前降支(left anterior descending branch,LAD)、右冠状动脉(right coronary artery,RCA)、左回旋支(left circumflex branch,LCX)和左主干(left main coronary artery,LM).老年女性冠心病患者中高血压、糖尿病、高血脂的患病率均明显高于同龄男性(68.8%vs63.7%,25.5%vs19.4%,P<0.05; 19.7%vs11.8%,P<0.01).男性各组主动吸烟率显著高于同龄女性各组(70.7%vs1.2%; 50.5%vs3.6%,P<0.01).结论与年龄相关的雌激素变化对女性冠心病患者危险因素及冠状动脉病变进程有明显影响.女性患者不典型胸痛发生率显著高于同龄男性,女性冠心病患者CAG的阳性率、多支病变率、冠脉阻塞程度均显著低于同龄男性.老年女性冠心病患者中高血压、糖尿病、高血脂症的发生率均显著高于老年男性,而男性的主动吸烟率明显高于女性.