孙程程,熊辉

• 1:北京大学第一医院急诊科

摘要(Abstract)：

目的分析绝经前女性急性心肌梗死相关临床特点和发病危险因素,为临床诊治提供一定的思路。方法回顾性分析2009年1月至2019年11月北京大学第一医院心内科住院的确诊为急性心肌梗死的18～50岁绝经前女性患者58例(其中青年女性组患者20例,中年女性组患者38例),同期匹配男性患者116例。比较不同组间临床特点,logistic单因素及多因素分析采用二元回归分析发病危险因素。结果女性组患者合并高血压病38例(65.5%)、男性组患者69例(59.5%);女性组患者合并糖尿病21例(36.2%),男性组患者37例(31.9%)。女性组患者典型胸痛发作(69.0%比83.6%,P=0.026)、既往心绞痛发作(31.0%比62.1%,P<0.001)、ST段抬高型心肌梗死(41.4%比66.4%,P=0.002)、吸烟(13.8%比83.6%,P <0.001)、脂代谢紊乱的比例(36.2%比70.7%,P<0.001)及体重指数(BMI)[(24.14±3.48)kg/m2比(25.87±2.99)kg/m2,P=0.001]、血清肌酐[69.5(45.0,874.0)μmol/L比87.0(50.0,1487.0)μmol/L,P<0.001]、三酰甘油[1.45(0.43,11.65)mmol/L比1.81(0.55,6.02)mmol/L,P=0.035]水平均显著低于男性组患者,但慢性肾病比例(22.4%比6.9%,P=0.003)及心肌梗死后左心室射血分数<50%比例(37.9%比20.7%,P=0.015)均显著高于男性组患者,差异均有统计学意义。青年女性组患者慢性肾病比例(40.0%比13.2%,P=0.043)、血液透析比例(35.0%比10.5%,P=0.042)及收缩压[(151.40±25.43)mmHg(1 mmHg=1.33 kPa)比(133.55±30.01)mmHg,P=0.032]、舒张压[(91.90±16.96)mmHg比(80.66±18.91)mmHg,P=0.034]均显著多于中年女性组患者,差异均有统计学意义。将不同性别比较的logistic多因素回归分析显示,年龄(OR 0.902,95%CI0.831～0.980,P=0.015)、既往心绞痛(OR 2.770,95%CI 1.138～7.751,P=0.026)、吸烟(OR 36.201,95%CI 12.495～104.883,P<0.001)、脂代谢紊乱(OR4.988,95%CI 1.844～13.493,P=0.002)和慢性肾病(OR 0.220,95%CI0.056～0.868,P=0.031)与冠心病危险因素相关。logistic多因素回归分析结果显示,青年组与中年组女性患者4个指标(慢性肾病、血液透析、入院查体收缩压及舒张压)均未显示与冠心病危险因素相关。结论绝经前发生心肌梗死的女性中慢性肾病的发病率高。慢性肾病是重要的冠心病危险因素。在患有慢性肾病的中青年女性患者中,应重视冠心病的预防工作。

关键词(KeyWords)： 急性心肌梗死;绝经前女性;危险因素;慢性肾病

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 孙程程,熊辉

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