田庄,田然,刘震宇,曾勇,张抒扬

• 1:中国医学科学院北京协和医学院北京协和医院心内科

摘要(Abstract)：

目的探讨青年女性急性心肌梗死患者的临床和冠状动脉造影特点。方法入选2007年至2012年于北京协和医院诊断为急性心肌梗死并行冠状动脉造影的青年女性(年龄18~44岁)共24例,选取同时期急性心肌梗死并行冠状动脉造影的老年女性(年龄≥65岁)70例为对照组,回顾性分析并比较其临床和冠状动脉造影的情况。结果 24例患者中有9例证实为非动脉粥样硬化性心肌梗死,较15例动脉粥样硬化性心肌梗死的青年女性患者年龄更小、体质量指数(BMI)更低、传统的冠心病危险因素较少(P均<0.05),冠状动脉造影显示无病变和主干病变较多(P均<0.05)。动脉粥样硬化性心肌梗死的青年女性患者中8例(53.3%)合并2个以上的传统危险因素。与老年心肌梗死女性相比,青年心肌梗死女性传统的冠心病危险因素个数较少,入院时的收缩压、空腹血糖、血肌酸酐、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平较低;冠状动脉造影显示单支病变更多见(P均<0.05)。结论青年女性急性心肌梗死时需要考虑非动脉粥样硬化因素。动脉粥样硬化性心肌梗死的青年女性患者较老年女性心肌梗死患者的危险因素少,冠状动脉病变以单支为主。

关键词(KeyWords)： 急性心肌梗死;冠状动脉造影;女性;危险因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 田庄,田然,刘震宇,曾勇,张抒扬

参考文献(References)：

• [1]Lemer DJ,Kannel WB.Pattems of coronary heart disease morbidity and mortality in the sexes:a 26-year follow-up of the Framingham population.Am Heart J,1986,111:383-390.
• [2]Jinnouchi H,Sakakura K,Wada H,et al.Clinical features of myocardial infarction in young Japanese patients.Int Heart J,2013,54:123-128.
• [3]李昭,李志忠,高玉龙,等.青年女性急性心肌梗死的危险因素及冠状动脉病变特点.中华心血管病杂志,2012,40:225-230.
• [4]Adao L,Santos L,Bettencourt N,et a1.Acute coronary syndromes in young women.Rev Port Cardiol,2004,23:69-77.
• [5]Schoenenberger AW,Radovanovic D,Stauffer JC,et al.Acute coronary syndromes in young patients:presentation,treatment and outcome.Int J Cardiol,2011,148:300-304.
• [6]刘兆平,洪涛,李建平,等.女性早发冠心病患者的临床及冠状动脉造影特征.中国介入心脏病学杂志,2009,17:39-42.
• [7]Krumholz HM,Anderson JL,Brooks NH,et al.ACC/AHA clinical performance measures for adults with ST-elevation and non-STelevation myocardial infarction:a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures(Writing Committee to Develop Performance Measures on ST-Elevation and Non-ST-Elevation Myocardial Infarction).Circulation,2006,113:732-761.
• [8]Da Costa A1,Isaaz K,Faure E,et al.Clinical characteristics,aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram;a 3-year follow-up study of 91 patients.Eur Heart J,2001,22:1459-1465.
• [9]蒋雄京,杨跃进,高润霖.大动脉炎累及冠状动脉的分析.中华内科杂志,2002,41:592-594.
• [10]Manzi S,Meilahn E,Rairie J,et al.Age-specifi c incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus:comparison with the Framingham study.Am J Epidemiol,1997,145:408-415.
• [11]Chang CJ,Wu CH,Yao WJ,et a1.Relationships of age,menopause and central obesity on cardiovascular disease risk factors in Chinese women.Int J Obes Relat Metab Disord,2000,24:1699-1704.
• [12]Shaw LJ,Bairey Merz CN,Pepine CJ,et al.Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation(WISE)Study:Part I:gender differences in traditional and novel risk factors,symptom evaluation,and gender-optimized diagnostic strategies.J Am Coll Cardiol,2006,47:S4-S20.
• [13]Akosah KO,Cemiglia RM,Havlik P,et a1.Myocardial infarction in young adults with low-density lipoprotein cholesterol levels
• [14]Shaw LJ,Lewis JF,Hlatky MA,et al.Women’s Ischemic Syndrome Evaluation:current status and future research directions,report of the National Heart Lung Blood Institute(NHLBI)workshop,section 5:gender-related risk factors for ischemic heart disease.Circulation,2004,109:e56–e58.