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目的分析青年人(<45岁)急性心肌梗死(acute myocardial infarction,AMI)发病的临床表现特点和冠状动脉病变特点,探讨其病因及防治措施。方法回顾性分析34例青年AMI患者和同期40例中老年(≥45岁)AMI患者的临床资料,对两组危险因素、诱因、心脏超声检查结果及冠状动脉病变特点等进行对比分析。结果青年组以男性为主,且男性所占百分数明显高于老年组[85.3%(29/34)vs.60.0%(24/40),P<0.05],大量吸烟史患者百分数明显高于老年组[82.3%(28/34)vs.45.0%(18/40),P<0.05],起病时呈典型胸痛症状患者百分数明显高于老年组[88.2%(30/34)vs.50.0%(20/40),P<0.05];青年组AMI后心脏超声下左心室扩大、射血分数降低患者百分数明显低于老年组[70.6%(24/34)vs.35.0%(14/40),P<0.05;64.7%(22/34)vs.35.0%(14/40),P<0.05],左心室短轴切面室壁节段性变薄患者百分数明显高于老年组[52.9%(18/34)vs.15.0%(6/40),P<0.05];青年组表现为ST段抬高型心肌梗死的患者百分数高于老年组[76.5%(26/34)vs.40.0%(16/40),P<0.05],冠状动脉单支病变患者百分数明显高于老年组[88.2%(30/34)vs.25.0%(10/40),P<0.05]。结论青年AMI患者以男性为主,吸烟为其主要危险因素,症状典型,病变以单支病变为主,心肌受损程度较小,预后较好。
Objective To analyze the clinical features and the characteristics of coronary lesions in young people (<45 years old) with acute myocardial infarction (AMI) and to explore their etiology and prevention and treatment. Methods The clinical data of 34 young AMI patients and 40 middle-aged and elderly patients (≥45 years old) with AMI were retrospectively analyzed. The risk factors, causes, echocardiographic findings and characteristics of coronary lesions were compared between the two groups. Results The percentage of male patients in youth group was significantly higher than that in the elderly group (85.3% vs 29.0%, P <0.05), and the percentage of patients with heavy smoking history was significantly higher than that of the elderly Group [82.3% (28/34) vs.45.0% (18/40), P <0.05]. The percentage of patients with typical chest pain onset was significantly higher than that of the elderly group [88.2% (30/34) vs. 50.0% (20/40), P <0.05]. The percentage of patients with left ventricular enlargement and ejection fraction decrease after AMI in young group was significantly lower than that in the elderly group [70.6% (24/34) vs.35.0% (14/40) , P <0.05; 64.7% (22/34) vs.35.0% (14/40), P <0.05]. The percentage of patients with segmental wall thinning in left ventricular short axis section was significantly higher than that in the elderly group [52.9% 18/34) vs.15.0% (6/40), P <0.05]. The percentage of patients with ST-segment elevation myocardial infarction in the youth group was higher than that in the elderly group [76.5% (26/34) vs.40.0% P <0.05]. The percentage of patients with single coronary artery disease was significantly higher than that of the elderly group [88.2% (30/34) vs.25.0% (10/40), P <0.05]. Conclusions Young patients with AMI are predominantly male and smoking is the major risk factor. The symptoms are typical, the lesions are mainly single vessels, the myocardial damage is minor, and the prognosis is good.