CAJ | 학술논문

目的探讨急性ST段抬高心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）中不同性别患者临床特点及预后的差异。方法采用回顾性分析，选择211例首次发作STEMI经急诊PCI患者，收集临床、造影、介入及心脏超声资料。以性别分组比较基本临床资料、入院检查及治疗情况、早期心功能之间的差异。t检验进行分析。计量资料以率表示，两组间行χ2检验以Fisher精确概率法进行分析。相关危险因素分析应用 Logistic 回归分析。结果男性患者176例，女性患者35例，行急诊PCI占16．59％。纳入各项指标分析，女性患者年龄较大[（67±8）岁比（60±11）岁]，合并症较多、吸烟较少、症状持续时间更长。女性患者血小板平均体积、总胆固醇、低密度脂蛋白胆固醇水平较男性组高[（12．32±0．97）fl 比（11．72±1．27）fl，（4．98±1．13）mmol／L 比（4．46±1．02）mmol／L，（3．10±0．85）mmol／L 比（2．65±0．79）mmol／L，P＜0．01]，肌酐、血红蛋白较男性组低（P＜0．05）。住院期间药物治疗、冠状动脉造影及PCI资料、住院时间和院内病死率性别间差异无统计学意义。Logistic回归模型显示，女性（OR＝2．50，95％CI＝1．06～5．89，P＝0．036）和前降支梗塞（OR＝6．35，95％CI＝3．44～11．71，P＜0．001）可作为左室射血分数＜50％发生的独立预测因子。结论初发STEMI女性患者年龄大、合并症多，存在就诊延迟，在行急诊PCI后女性患者左心收缩功能更差。
목적탐토급성ST단태고심기경사（STEMI）환자급진경피관상동맥개입치료（PCI）중불동성별환자림상특점급예후적차이。방법채용회고성분석，선택211례수차발작STEMI경급진PCI환자，수집림상、조영、개입급심장초성자료。이성별분조비교기본림상자료、입원검사급치료정황、조기심공능지간적차이。t검험진행분석。계량자료이솔표시，량조간행χ2검험이Fisher정학개솔법진행분석。상관위험인소분석응용 Logistic 회귀분석。결과남성환자176례，녀성환자35례，행급진PCI점16．59％。납입각항지표분석，녀성환자년령교대[（67±8）세비（60±11）세]，합병증교다、흡연교소、증상지속시간경장。녀성환자혈소판평균체적、총담고순、저밀도지단백담고순수평교남성조고[（12．32±0．97）fl 비（11．72±1．27）fl，（4．98±1．13）mmol／L 비（4．46±1．02）mmol／L，（3．10±0．85）mmol／L 비（2．65±0．79）mmol／L，P＜0．01]，기항、혈홍단백교남성조저（P＜0．05）。주원기간약물치료、관상동맥조영급PCI자료、주원시간화원내병사솔성별간차이무통계학의의。Logistic회귀모형현시，녀성（OR＝2．50，95％CI＝1．06～5．89，P＝0．036）화전강지경새（OR＝6．35，95％CI＝3．44～11．71，P＜0．001）가작위좌실사혈분수＜50％발생적독립예측인자。결론초발STEMI녀성환자년령대、합병증다，존재취진연지，재행급진PCI후녀성환자좌심수축공능경차。
Objective To investigate the presence of gender differences in clinical characteristics in patients presenting with first acute ST-segment elevation myocardial infarction(STEMI),treated with primary percutaneous coronary intervention (PCI).Methods A total of 21 1 patients(1 6.59% women)presenting with STEMI who underwent primary PCI within 1 2 hours following onset of ischemic symptoms were selected. Those patients were divided into male group (n =1 76 ) and female group (n =35 ). Clinical data, angiography findings,PCI procure data and echocardiographic evaluation were compared between genders. Results Compared with male group,female had older mean age[(67 ±8)years vs (60 ±1 1 )years,P=0.001 ],more co-morbidities and longer symptom duration [(428 ±228 )min vs (331 ±232 )min,P=0.024],whereas,the rate of smoking habit was significantly lower in female than that in male group(P<0.001 ).Female had higher mean platelet volume,total cholesterol,LDL-C than male,whereas,male had higher creatinine and hemoglobin than female.There were no difference in hospital care,length of hospital stay and in-hospital mortality between each group.A logistic multivariate analysis model revealed that female (OR=2.50,95%CI 1 .06-5.89,P=0.036),anterior myocardial infarction(OR=6.35,95%CI:3.44-1 1 .71 ,P<0.001 )were positively associated with left ventricular ejection fractions<50%.Conclusions Female following first STEMI are older,more co-morbidities and longer symptom duration.Despite receiving similar treatment as male patients,female patients demonstrate a worse systolic left ventricular function.