中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
4期
1517-1521
,共5页
朱定君%石蓓%夏鸿莉%张凯%吴勇波%刘紫燕%金道群%李振龙%赵琳%蔡丽芹%陈志强
硃定君%石蓓%夏鴻莉%張凱%吳勇波%劉紫燕%金道群%李振龍%趙琳%蔡麗芹%陳誌彊
주정군%석배%하홍리%장개%오용파%류자연%금도군%리진룡%조림%채려근%진지강
心肌梗死%冠状动脉疾病%吸烟%男(雄)性
心肌梗死%冠狀動脈疾病%吸煙%男(雄)性
심기경사%관상동맥질병%흡연%남(웅)성
Myocardial infarction%Coronary artery disease%Smoking%Male
目的观察吸烟对40岁以下初发急性心肌梗死（ AMI ）的男性患者冠状动脉病变的影响。方法入选确诊首发急性心肌梗死的40岁以下男性260例，根据吸烟情况分为吸烟组（ n＝192）和不吸烟组（n＝68），皆排除合并有高血压、高胆固醇及糖尿病等冠心病主要危险因素病例。通过冠状动脉造影分析患者的冠状动脉病变特点。结果两组平均年龄相近，均以单支病变为主，三支病变较少。吸烟组单支病变比例低于不吸烟组（50.5％vs．75.0％，P＜0.001），而双支病变比例高于不吸烟组（29.2％ vs．14.7％，P＜0.05）。吸烟组0支病变和三支病变比例高于不吸烟组（13.0％vs．7.4％，7.3％vs．2.9％），但无统计学意义（P＞0．05）。单支病变亚组中，两组均以左前降支病变为主，右冠状动脉次之，回旋支较少。吸烟组右冠状动脉病变比例高于不吸烟组（21.4％vs．10.3％，P＜0.05），不吸烟组左前降支病变明显高于吸烟组（61.0％vs．24.5％，P＜0.001）。双支病变亚组中，包含右冠状动脉病变组合（右冠状动脉＋左前降支及右冠状动脉＋回旋支）比例吸烟患者多见，和不吸烟组比较，均有统计学意义（ P＜0.05）。另外，吸烟组冠状动脉瘤样扩张比例明显高于不吸烟组（12.5％vs．2.9％，P＜0.05），且吸烟者大多数发生于右冠状动脉（共20例占83％）。吸烟组Gensini积分亦高于不吸烟组（49.5±33.9 vs．39.3±26.4，P＜0.05）。结论不合并其他危险因素的吸烟青年男性AMI患者病变程度重于不合并其他危险因素非吸烟AMI患者；与不吸烟患者比较，其右冠状动脉狭窄病变及冠状动脉瘤样扩张病变尤其右冠状动脉动脉瘤样扩张病变均多见。
目的觀察吸煙對40歲以下初髮急性心肌梗死（ AMI ）的男性患者冠狀動脈病變的影響。方法入選確診首髮急性心肌梗死的40歲以下男性260例，根據吸煙情況分為吸煙組（ n＝192）和不吸煙組（n＝68），皆排除閤併有高血壓、高膽固醇及糖尿病等冠心病主要危險因素病例。通過冠狀動脈造影分析患者的冠狀動脈病變特點。結果兩組平均年齡相近，均以單支病變為主，三支病變較少。吸煙組單支病變比例低于不吸煙組（50.5％vs．75.0％，P＜0.001），而雙支病變比例高于不吸煙組（29.2％ vs．14.7％，P＜0.05）。吸煙組0支病變和三支病變比例高于不吸煙組（13.0％vs．7.4％，7.3％vs．2.9％），但無統計學意義（P＞0．05）。單支病變亞組中，兩組均以左前降支病變為主，右冠狀動脈次之，迴鏇支較少。吸煙組右冠狀動脈病變比例高于不吸煙組（21.4％vs．10.3％，P＜0.05），不吸煙組左前降支病變明顯高于吸煙組（61.0％vs．24.5％，P＜0.001）。雙支病變亞組中，包含右冠狀動脈病變組閤（右冠狀動脈＋左前降支及右冠狀動脈＋迴鏇支）比例吸煙患者多見，和不吸煙組比較，均有統計學意義（ P＜0.05）。另外，吸煙組冠狀動脈瘤樣擴張比例明顯高于不吸煙組（12.5％vs．2.9％，P＜0.05），且吸煙者大多數髮生于右冠狀動脈（共20例佔83％）。吸煙組Gensini積分亦高于不吸煙組（49.5±33.9 vs．39.3±26.4，P＜0.05）。結論不閤併其他危險因素的吸煙青年男性AMI患者病變程度重于不閤併其他危險因素非吸煙AMI患者；與不吸煙患者比較，其右冠狀動脈狹窄病變及冠狀動脈瘤樣擴張病變尤其右冠狀動脈動脈瘤樣擴張病變均多見。
목적관찰흡연대40세이하초발급성심기경사（ AMI ）적남성환자관상동맥병변적영향。방법입선학진수발급성심기경사적40세이하남성260례，근거흡연정황분위흡연조（ n＝192）화불흡연조（n＝68），개배제합병유고혈압、고담고순급당뇨병등관심병주요위험인소병례。통과관상동맥조영분석환자적관상동맥병변특점。결과량조평균년령상근，균이단지병변위주，삼지병변교소。흡연조단지병변비례저우불흡연조（50.5％vs．75.0％，P＜0.001），이쌍지병변비례고우불흡연조（29.2％ vs．14.7％，P＜0.05）。흡연조0지병변화삼지병변비례고우불흡연조（13.0％vs．7.4％，7.3％vs．2.9％），단무통계학의의（P＞0．05）。단지병변아조중，량조균이좌전강지병변위주，우관상동맥차지，회선지교소。흡연조우관상동맥병변비례고우불흡연조（21.4％vs．10.3％，P＜0.05），불흡연조좌전강지병변명현고우흡연조（61.0％vs．24.5％，P＜0.001）。쌍지병변아조중，포함우관상동맥병변조합（우관상동맥＋좌전강지급우관상동맥＋회선지）비례흡연환자다견，화불흡연조비교，균유통계학의의（ P＜0.05）。령외，흡연조관상동맥류양확장비례명현고우불흡연조（12.5％vs．2.9％，P＜0.05），차흡연자대다수발생우우관상동맥（공20례점83％）。흡연조Gensini적분역고우불흡연조（49.5±33.9 vs．39.3±26.4，P＜0.05）。결론불합병기타위험인소적흡연청년남성AMI환자병변정도중우불합병기타위험인소비흡연AMI환자；여불흡연환자비교，기우관상동맥협착병변급관상동맥류양확장병변우기우관상동맥동맥류양확장병변균다견。
Objective To investigate the effect of smoking on coronary characteristics of ≤40 years male smokers with first acute myocardial infarction (AMI).Methods A total of 260 men(≤40 years)diagnosed with first AMI were included in this study,they were divided into smokers group (n=192) and nonsmokers group(n=68) according to smoking status , all those patients with either hypertension , hypercholesterolemia or diabetes were excluded.Coronary angiography was performed in all of them before hospital discharge and coronary lesions were assessed.Results Two groups had a similar age ,and were more likely to have single-vessel disease and less likely to have triple-vessel disease .The percentage of patients with single-vessel disease was lower in smokers than nonsmokers (50.5%vs.75.0%,P<0.001),whereas,the percentage double-vessel disease was higher in smokers than non-smokers(29.2%vs.14.7%,P<0.05).Also,incidence of zero-vessel disease and triple-vessel disease was higher in smokers than nonsmokers(13.0%vs.7.4%,7.3%vs.2.9%,respectively),but there were no significant differences (both P>0.05).Among the patients with single-vessel disease,coronary obstruction was most frequently found in the left anterior descending artery , followed by the right and circumflex arteries .A higher percentage of smoking patients,however,had right coronary disease than nonsmokers (21.4% vs.10.3%,P<0.05).In contrast,smokers had less frequent obstruction in anterior descending artery than nonsmokers ( 61.0% vs.24.5%, P <0.001 ) . Similarly among patterns of double-vessel disease ,the two distributions including the right coronary artery were more prevalent in smokers than in nonsmokers .Both differences were significantly different ( P <0.05 ).In addition,coronary artery ectasias were more popular in smokers compared with non-smokers.Especially,ectasia most frequently affected the right coronary artery ( 20 patients ) among smokers .Gensini scores was significantly higher in patients among smokers than those among nonsmokers .Conclusions Smoking is linked with severe coronary artery lesion in young male patients with AMI .Compared with nonsmokers ,both the right coronary disease and the coronary artery ectasias,which were also most frequently found in the right coronary ,were more popular.
