CAJ | 학술논문

目的探讨早发急性冠状动脉综合征患者的临床特点.方法回顾性分析2011年1月至2013年6月在北京协和医院心内科住院、行冠状动脉造影并确诊为急性冠状动脉综合征的患者347例.将患者分为早发组(冠心病发病年龄男性＜55岁,女性＜65岁,共140例)和非早发组(冠心病发病年龄男性≥55岁,女性≥65岁,共207例).分析患者的危险因素、冠状动脉造影特点及住院期间转归.结果 (1)与非早发组比较,早发组吸烟[56.4％(79/140)比44.4％(92/207),P ＜0.05]、血脂异常[61.4％ (86/140)比50.2％(104/207),P＜0.05]、冠心病家族史[39.3％(55/140)比24.6％ (51/207),P＜0.01]的比例均较高,危险因素数量较少[(3.03±1.28)个比(3.91±1.30)个,P＜0.01].(2)早发组冠状动脉以单支和双支病变为主(63.6％,89/140),非早发组以多支病变为主(57.0％,118/207);早发组冠状动脉闭塞病变的比例高于非早发组[45.7％(64/140)比34.8％ (72/207),P＜0.05];Gensini评分早发组低于非早发组[(46.2±33.2)分比(60.4±37.5)分,P＜0.01].(3)与非早发组比较,早发组住院期间发生重度慢性心力衰竭(NYHA分级≥Ⅲ级)的比例较低[4.3％ (6/140)比11.1％ (23/207),P＜0.05],住院30 d无死亡的比例差异无统计学意义[0比1.9％ (4/207),P＞0.05].结论吸烟、血脂异常、冠心病家族史是早发急性冠状动脉综合征患者的主要危险因素.早发急性冠状动脉综合征患者冠状动脉病变程度较轻,重度慢性心力衰竭发生率较低.
목적 탐토조발급성관상동맥종합정환자적림상특점.방법 회고성분석2011년1월지2013년6월재북경협화의원심내과주원、행관상동맥조영병학진위급성관상동맥종합정적환자347례.장환자분위조발조(관심병발병년령남성＜55세,녀성＜65세,공140례)화비조발조(관심병발병년령남성≥55세,녀성≥65세,공207례).분석환자적위험인소、관상동맥조영특점급주원기간전귀.결과 (1)여비조발조비교,조발조흡연[56.4％(79/140)비44.4％(92/207),P ＜0.05]、혈지이상[61.4％ (86/140)비50.2％(104/207),P＜0.05]、관심병가족사[39.3％(55/140)비24.6％ (51/207),P＜0.01]적비례균교고,위험인소수량교소[(3.03±1.28)개비(3.91±1.30)개,P＜0.01].(2)조발조관상동맥이단지화쌍지병변위주(63.6％,89/140),비조발조이다지병변위주(57.0％,118/207);조발조관상동맥폐새병변적비례고우비조발조[45.7％(64/140)비34.8％ (72/207),P＜0.05];Gensini평분조발조저우비조발조[(46.2±33.2)분비(60.4±37.5)분,P＜0.01].(3)여비조발조비교,조발조주원기간발생중도만성심력쇠갈(NYHA분급≥Ⅲ급)적비례교저[4.3％ (6/140)비11.1％ (23/207),P＜0.05],주원30 d무사망적비례차이무통계학의의[0비1.9％ (4/207),P＞0.05].결론 흡연、혈지이상、관심병가족사시조발급성관상동맥종합정환자적주요위험인소.조발급성관상동맥종합정환자관상동맥병변정도교경,중도만성심력쇠갈발생솔교저.
Objective To analyze the clinical features of patients with premature acute coronary syndrome (ACS).Methods Three hundreds and forty seven patients with ACS who underwent coronary angiography from January 2011 to June 2013 in our department were included in this study.Eligible patients were divided into premature group (pre-group,male ＜ 55 years old,female ＜ 65 years old,n =140) and non-premature group(N-pre group,male ≥55 years old,female ≥65 years old,n =207).The cardiovascular risk factors,coronary angiography (CAG) features,complications and in-hospital mortality were analyzed.Results Compared to N-pre group,the pre-group had a significantly higher rate of smoking [56.4％ (79/140) vs.44.4％ (92/207),P ＜ 0.05],dyslipidemia [61.4％ (86/140) vs.50.2％ (104/207),P ＜0.05] and positive family history of coronary artery disease [39.3 ％ (55/140) vs.24.6％ (51/207),P ＜0.01].However,other traditional cardiovascular risk factors were less(3.03 ± 1.28 vs.3.91 ± 1.30,P ＜0.01).CAG identified higher incidence of one-vessel and double-vessel diseases (63.6％,89/140) in pregroup,but the incidence of multi-vessel diseases(57.0％,118/207) was more frequent in N-pre group.Moreover,the pre-group had a higher rate of coronary artery occlusion [45.7％ (64/140) vs.34.8％ (72/207),P＜ 0.05].Compared with N-pre group,the pre-group had a lower Gensini Score of CAG (46.2 ± 33.2 vs.60.4 ± 37.5,P ＜ 0.01) and a lower rate of heart failure [4.3 ％ (6/140) vs.11.1％ (23/207),P ＜ 0.05] during hospitalization.In-hospital mortality rate was similar between the two groups [0 vs.1.9％ (4/207),P ＞ 0.05].Conclusion Smoking,dyslipidemia and family history of coronary artery disease are major risk factors for patients with premature ACS,these patients are more likely to have milder coronary artery stenosis and a lower incidence of heart failure compared to N-pre group.