2020 年第 1 期 第 15 卷

不同年龄急性ST段抬高型心肌梗死患者临床及冠状动脉病变特点

Clinical and coronary features of acute ST-elevation myocardial infarction at different ages

作者：付丽董茜韩晓涛王茜

英文作者：

单位：首都医科大学附属北京地坛医院心内科100015

英文单位：

关键词：急性ST段抬高型心肌梗死；年龄；危险因素

英文关键词：

• 摘要：

• 【摘要】目的    分析不同年龄急性ST段抬高型心肌梗死(STEMI)患者的临床和冠状动脉病变特点，以根据年龄提供不同的诊疗建议。方法    纳入2016年5月至2018年8月首都医科大学附属北京地坛医院胸痛中心行急诊经皮冠状动脉介入的急性STEMI患者496例，依据年龄分为≤44岁青年组（A组，66例）、45～59岁中年组（B组，215例）、60～74岁年轻老年组（C组，147例）、≥75岁老年组（D组，68例）。比较各组基本资料、生化指标和冠状动脉病变情况。结果    A、B组患者男性、吸烟比例均明显高于C、D组，脑血管疾病比例均明显低于C、D组，A组体重指数高于C、D组，B组高于D组（均P＜0.05）。A组患者的三酰甘油、总胆固醇、非高密度脂蛋白胆固醇、载脂蛋白B、血尿酸、血红蛋白水平明显高于C、D组，脂蛋白a及血肌酐水平明显低于D组（均P＜0.05）。各组罪犯血管比例比较，差异均无统计学意义（均P＞0.05）。A组单支病变比例明显高于D组［51.5%(34/66)比8.8%(6/68)］，三支病变比例明显低于D组［22.7%(15/66)比47.1%(32/68)］（均P＜0.05）。结论    青中年患者对戒烟、控制体质量和对三酰甘油、血尿酸水平的干预应更为积极，对血红蛋白的异常升高应提高警惕。老年患者对于血脂、血糖、血压、血尿酸等应全方位控制达标。

• 【Abstract】Objective    To analyze the clinical features and coronary artery lesions of acute ST-segment elevation myocardial infarction(STEMI) at different ages. Methods    Totally 496 patients with acute STEMI who underwent emergency percutaneous coronary intervention in Beijing Ditan Hospital, Capital Medical University from May 2016 to August 2018 were enrolled. According to their age, the patients were divided into 4 groups: ≤44 years old(group A, 66 cases), 45-59 years old(group B, 215 cases), 60-74 years old(group C, 147 cases) and ≥75 years old(group D, 68 cases). Basic clinical data, biochemical indicators and coronary artery lesions were analyzed. Results    Male rate, smoking rate and body mass index in group A and B were significantly higher and rate of cerebrovascular disease was lower than those in group C and D; body mass index in group A was significantly higher than that in group C and D; body mass index in group B was significantly higher than that in group D（all P＜0.05）. Levels of serum triglyceride, total cholesterol, non-high density lipoprotein cholesterol, apolipoprotein B, serum uric acid and hemoglobin in group A were significantly higher than those in group C and D, and the levels of lipoprotein-a and serum creatinine were significantly lower than those in group D(all P＜0.05). There was no significant difference in culprit vessels among groups(P＞0.05). Rate of single vessel lesion in group A was significantly higher［51.5%(34/66) vs 8.8%(6/68)］ and rate of three vessel lesions was lower［22.7%(15/66) vs 47.1%(32/68)］ than those in group D(both P＜0.05). Conclusions    Young and middle-aged patients with acute STEMI should recognize the importance of smoking cessation, weight control, close attention on serum triglyceride, uric acid and hemoglobin levels. Elderly patients should comprehensively control blood lipid, blood sugar, blood pressure and blood uric acid.