CAJ | 학술논문

目的探讨老年心肌梗死伴与不伴室壁瘤形成的临床病理差异.方法对107例经尸检证实的老年人(60～90岁)心肌梗死按伴与不伴室壁瘤形成分为室壁瘤组与对照组(室壁瘤组31例,对照组76例)进行临床病理对照分析.结果室壁瘤组有心绞痛史者占45.2％( 14/31),少于对照组的92.1％(70/76,P=0.047).室壁瘤组合并高血压77.4％( 24/31),多于对照组的36.8％( 28/76,P=0.033).室壁瘤组冠状动脉单支病变占54.8％(17/31),多于对照组的23.7％( 18/76,P=0.033)；前降支严重病变(狭窄大于Ⅲ级)占96.8％(30/31),多于对照组的51.3％ (39/76,P=0.048).室壁瘤组的死亡原因以心力衰竭和室性心律失常多见[56.3％ (18/31)],室壁瘤形成部位则以前壁及心尖处多见[87.1％(27/31)].结论老年心肌梗死伴室壁瘤形成患者多合并高血压,既往常无心绞痛史,冠状动脉以前降支单支严重病变常见,死亡原因以心力衰竭和室性心律失常多见,室壁瘤部位则多见于前壁及心尖处.
목적 탐토노년심기경사반여불반실벽류형성적림상병리차이.방법 대107례경시검증실적노년인(60～90세)심기경사안반여불반실벽류형성분위실벽류조여대조조(실벽류조31례,대조조76례)진행림상병리대조분석.결과 실벽류조유심교통사자점45.2％( 14/31),소우대조조적92.1％(70/76,P=0.047).실벽류조합병고혈압77.4％( 24/31),다우대조조적36.8％( 28/76,P=0.033).실벽류조관상동맥단지병변점54.8％(17/31),다우대조조적23.7％( 18/76,P=0.033)；전강지엄중병변(협착대우Ⅲ급)점96.8％(30/31),다우대조조적51.3％ (39/76,P=0.048).실벽류조적사망원인이심력쇠갈화실성심률실상다견[56.3％ (18/31)],실벽류형성부위칙이전벽급심첨처다견[87.1％(27/31)].결론 노년심기경사반실벽류형성환자다합병고혈압,기왕상무심교통사,관상동맥이전강지단지엄중병변상견,사망원인이심력쇠갈화실성심률실상다견,실벽류부위칙다견우전벽급심첨처.
Objective To analyze the clinic-pathologic features of elderly myocardial infarction patients ( ＞ 60 years) with and without left ventricular aneurysm formation.Methods Between January 1980 and October 2009,107 myocardial infarction patients were divided into aneurysm group (n =31 ) and non-aneurysm group ( n = 76) according to autopsy results and the clinic-pathologic features of the two groups were compared.Results Previous angina pectoris history was significantly less in aneurysm group than in non-aneurysm group [ 45.2％ ( 14/31 ) vs.92.1％ ( 70/76 ),P = 0.047 ].Incidence of hypertension was significantly higher in aneurysm group than in non-aneurysm group [ 77.4％ (24/31) vs.36.8％ (28/76),P = 0.033 ].The percentage of single-vessel disease [54.8％ ( 17 /31 ) vs.23.7％(18/76),P =0.033] and the LAD disease [96.8％ (30/31) vs.51.3％ (39/76),P =0.048] were both significantly higher in aneurysm group than in non-aneurysm group.Heart failure and ventricular arrhythmias were more likely the cause of death in patients with aneurysm than patients without aneurysm [ 56.3％ (18/31) vs.19.7％ ( 15/76),P = 0.007 ].Aneurysm mostly located in left ventricular anterior wall and apex.Conclusions Our results suggest that patients with left ventricular aneurysm formation are more likely to have hypertension,single-vessel disease and LAD disease,heart failure and ventricular arrhythmias but less previous angina pectoris than patients without left ventricular aneurysm formation.The common locations of ventricular aneurvsm formation were left ventricular anterior wall and apex.