不同年龄段急性冠状动脉综合征患者的危险因素、冠状动脉病变特点及预后分析Analysis of risk factors,feature of coronary artery and prognosis of patients with acute coronary syndrome in different age groups
金彦彦,马长生,康俊萍,聂绍平,张崟,吕强,刘晓惠,董建增,胡荣
摘要(Abstract)：
目的探讨不同年龄段急性冠状动脉综合征(ACS)患者的危险因素、冠状动脉病变特点及预后。方法DESIRE为单中心回顾性注册研究,纳入接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的血运重建治疗的6005例患者。本研究从中选择ACS患者4865名,分为年龄<40岁组135名、40～49岁组738名、50～59岁1329名、60～75岁2425名、>75岁238名,回顾性分析其危险因素、冠状动脉病变特点及主要不良心脑血管事件(MACCE)发生率。结果ACS患者中以男性为主(男女之比为77.1%比22.9%,P<0.05),其中女性患者比例在50～59岁组(18.3%)、60～75岁组(30.6%)、年龄>75岁组(28.6%)比<40岁组(3.05%)、40～49岁组(7.5%)明显增加。50～59岁组、60～75岁组、年龄>75岁组患者以不稳定型心绞痛为主,而年龄<40岁组以急性ST段抬高心肌梗死多见。年龄<40岁组、40～49岁组患者多与吸烟、低高密度脂蛋白胆固醇水平、冠心病家族史有关;50～59岁组、60～75岁组及年龄>75岁组患者多与高血压、糖尿病有关。此外在60～75岁组及年龄>75岁组患者中血肌酐明显升高、血红蛋白显著下降,并且与其他各组间差异有统计学意义。冠状动脉病变支数随年龄增加而增加,且除60～75岁组(2.18±0.81支)与>75岁组(2.23±0.81支)之间差异无统计学意义外,其他各组(<40岁组1.67±0.81支,40～49岁组1.86±0.84支,50～59岁组2.04±0.85支)间差异有统计学意义。年龄>75岁组更多见到开口病变(12.2%)。年龄<40岁组及年龄>75岁组的血运重建类型差异无统计学意义。不同年龄组患者血运重建成功率差异无统计学意义。但年龄>75岁组患者完全血运重建率较低(66.8%),与其他各组(<40岁组81.5%,40～49岁组81.7%,50～59岁组78.7%,60～75岁组74.3%)相比,差异均有统计学意义(P均<0.001)。年龄>75岁组患者院内MACCE为5.0%,与其他各组(<40岁组0,40～49岁组2.0%,50～59岁组1.6%,60～75岁组2.6%)相比,差异均有统计学意义(P均<0.05)。年龄>75岁组患者随访MACCE为13.5%明显高于<40岁组(7.5%)和50～59岁组患者(8.1%),P均<0.05,但与其他组之间差异无统计学意义。年龄>75岁组患者院内死亡4.2%、随访死亡5.1%,与其他各组(<40岁组0和0,40～49岁组0.7%和1.5%,50～59岁组0和1.1%,60～75岁组1.4%和2.6%)之间差异有统计学意义,P均<0.05。Logist多因素回归分析发现,除年龄外,贫血(HR0.396,95%CI0.174～0.914,P=0.028)、完全血运重建率低(HR0.878,95%CI0.867～0.975,P=0.034)、肾功能下降(HR2.177,95%CI1.408～8.952,P=0.028)是独立危险因素。结论不同年龄组ACS患者的危险因素及冠状动脉病变有不同的特点,既要对多种危险因素进行综合干预,亦应有针对性地干预。年龄>75岁组患者是ACS患者中的高危人群,冠状动脉病变复杂,其院内及随访MACCE增加主要反映在死亡率的增加。这可能与>75岁患者冠状动脉病变复杂、完全血运重建率低、肾功能下降、贫血及合并其他疾病有关。
关键词(KeyWords)： 冠状动脉疾病;危险因素;预后
基金项目(Foundation): 国家重点基础研究发展规划基金资助项目(973计划)(2003CB517103)
作者(Author): 金彦彦,马长生,康俊萍,聂绍平,张崟,吕强,刘晓惠,董建增,胡荣
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