CAJ | 학술논문

目的探讨性别对高龄急性冠状动脉综合征(ACS)患者治疗策略的影响.方法选取2009年3月至2012年3月在青岛阜外心血管病医院心脏中心接受冠状动脉造影检查的高龄ACS患者619例,其中男346例,女273例.比较两组间危险因素、ACS诊断、冠状动脉造影结果、治疗方式及预后.结果危险因素方面,与男性组相比,女性的体质指数、脑卒中病史、吸烟史、血清血红蛋白、胆固醇、低密度脂蛋白胆固醇(LDL-C)、血尿酸水平均低于男性患者组(P＜0.05).女性的糖尿病患病率明显高于男性(27.8％比18.5％,P＜0.05).男性组既往有心肌梗死、经皮冠状动脉介入治疗(PCI)及冠状动脉旁路移植术(CABG)率明显大于女性(48.0％比39.9％,P＜0.05；30.6％比22.3％,P＜0.05;19.9％比10.3％,P＜0.01).女性合并多种危险因素(≥3个)者百分比明显增高(41.8％比29.8％,P＜0.05).ACS的诊断方面,女性发生不稳定性心绞痛(UAP)及非ST段抬高性心肌梗死(NSTEMI)的比率大于男性,但两者差异无统计学意义.女性组3支病变及钙化病变多于男性(36.3％比28.6％,P＜0.05).选择治疗策略方面,保守治疗的女性多于男性,二者差异无统计学意义.PCI的女性多于男性(26.0％比14.2％,P＜0.01).急诊PCI及择期CABG的男性比率多于女性(14.7％比6.6％,P＜0.01；19.1％比7.7％,P＜0.01).两组间预后差异无统计学意义.结论高龄女性ACS的治疗策略有一定的局限性,今后应该采取积极的治疗态度,改善预后.
목적 탐토성별대고령급성관상동맥종합정(ACS)환자치료책략적영향.방법 선취2009년3월지2012년3월재청도부외심혈관병의원심장중심접수관상동맥조영검사적고령ACS환자619례,기중남346례,녀273례.비교량조간위험인소、ACS진단、관상동맥조영결과、치료방식급예후.결과 위험인소방면,여남성조상비,녀성적체질지수、뇌졸중병사、흡연사、혈청혈홍단백、담고순、저밀도지단백담고순(LDL-C)、혈뇨산수평균저우남성환자조(P＜0.05).녀성적당뇨병환병솔명현고우남성(27.8％비18.5％,P＜0.05).남성조기왕유심기경사、경피관상동맥개입치료(PCI)급관상동맥방로이식술(CABG)솔명현대우녀성(48.0％비39.9％,P＜0.05；30.6％비22.3％,P＜0.05;19.9％비10.3％,P＜0.01).녀성합병다충위험인소(≥3개)자백분비명현증고(41.8％비29.8％,P＜0.05).ACS적진단방면,녀성발생불은정성심교통(UAP)급비ST단태고성심기경사(NSTEMI)적비솔대우남성,단량자차이무통계학의의.녀성조3지병변급개화병변다우남성(36.3％비28.6％,P＜0.05).선택치료책략방면,보수치료적녀성다우남성,이자차이무통계학의의.PCI적녀성다우남성(26.0％비14.2％,P＜0.01).급진PCI급택기CABG적남성비솔다우녀성(14.7％비6.6％,P＜0.01；19.1％비7.7％,P＜0.01).량조간예후차이무통계학의의.결론 고령녀성ACS적치료책략유일정적국한성,금후응해채취적겁적치료태도,개선예후.
Objective To explore the effects of gender on treatment strategies for elderly patients with acute coronary syndrome (ACS).Methods March 2009 to March 2012,consecutive 619 aged ACS patients undergoing coronary angiography (CA) were screened at our hospital.There were 273 females and 346 males.Risk factors,ACS diagnosis,CA results,treatments and prognosis were compared between female and male groups.Results The risk factors of body mass index,stroke history,smoking history,hemoglobin (Hb),serum cholesterol (TC),low density lipoprotein (LDL-C) and blood uric acid (UA) levels were significantly lower in female group than those in male group (P ＜ 0.05).The morbidity of diabetes in female group was obviously higher than that in male group (27.8％ vs 18.5％,P ＜0.05).The prevalence of myocardial infarction history,percutaneous coronary intervention (PCI) and coronary artery bypass grafting(CABG) history in male group were significantly greater than that in female group (48.0％ vs 39.9％,P＜0.05;30.6％ vs22.3％,P＜0.05; 19.9％ vs 10.3％,P＜0.01).The rate of combined multiple risk factors (3 or higher) increased significantly in female group (41.8％ vs 29.8％,P ＜ 0.05).The incidence of unstable angina pectoris (UAP) and non-ST segment elevation myocardial infarction (NSTEMI) in female group was greater,but there was no statistical significance.The rate of 3-vessel and calcification lesions in female group was significantly elevated compared with male group (36.26％ vs 28.61％,P ＜ 0.05).Regarding the choice of treatment strategy,conservative treatment was common in females,but there was no statistical significance between them.PCI,emergency PCI and selective CABG operation were performed more frequently in female group compared with male group (26.0％ vs 14.2％,P＜0.01; 14.7％ vs6.6％,P＜0.01; 19.1％ vs7.7％,P＜0.01).The prognosis had no statistical significance between two groups.Conclusion The treatment strategies have certain limitations for female ACS patients.And an more aggressive treatment should be offered to improve the prognosis.