摘要
目的:探讨青年非ST段抬高型心肌梗死(NSTEMI)患者的临床特点。方法:回顾性入选2009年1月至2013年7月诊断为急性心肌梗死并行冠状动脉造影检查且年龄≤40岁的593例患者。按照发病时心电图是否有ST段抬高,分为NSTEMI组(n=96)和ST段抬高型心肌梗死(STEMI)组(n=497),比较其危险因素、辅助检查结果、冠状动脉造影和血运重建情况。结果:NSTEMI占急性心肌梗死的比例为16.2%。NSTEMI组与STEMI组比较,高血压比例(49.0%vs.37.2%,P=0.031)、高脂血症比例(87.5%vs.76.3%,P=0.015)、肥胖比例(49.0%vs.35.8%,P=0.015)、总胆固醇[(4.66±1.50)mmol/L vs.(4.34±1.12)mmol/L,P=0.016]、低密度脂蛋白胆固醇(LDL-C)[(2.88±1.33)mmol/L vs.(2.56±0.97)mmol/L,P=0.006]和糖化血红蛋白[(6.37±1.28)%vs.(6.09±1.19)%,P=0.037]均较高;危险因素个数[(3.2±1.4)个vs.(2.8±1.2)个,P=0.004]、左心室射血分数[(61.74±8.02)%vs.(57.55±8.89)%,P<0.001]、三支/左主干病变比例(37.5%vs.27.2%,P=0.041)和置入支架数[(1.95±1.08)枚vs.(1.60±1.00)枚,P=0.007]也显著升高;中性粒细胞计数[(4.97±1.96)×10^(9)/L vs.(5.50±2.72)×10^(9)/L,P=0.023]和中性粒细胞/淋巴细胞比值[(2.36±1.27)vs.(2.81±2.01),P=0.006]均显著降低,差异均有统计学意义。NSTEMI组存在血管闭塞的比例为29.2%,以左回旋支比例最高,占14.6%。二元Logistic回归分析表明,LDL-C和肥胖是NSTEMI的独立相关因素[OR(95%CI):1.297(1.070~1.572),P=0.008;OR(95%CI):1.633(1.034~2.578),P=0.035]。结论:青年NSTEMI和STEMI患者相比,具有更多的危险因素,冠状动脉病变更重,置入支架数更多;LDL-C和肥胖是NSTEMI的独立相关因素。
Objectives:To investigate the clinical features of young adults with non-ST-segment elevation myocardial infarction(NSTEMI).Methods:A total of 593 young patients(≤40 years old)diagnosed with acute myocardial infarction(AMI)and undergoing coronary angiography at Fuwai Hospital from 2009 to 2013 were enrolled retrospectively in this study.The patients were divided into the NSTEMI group(n=96)and the STEMI group(n=497).Risk factors,examination results,coronary angiography and revascularization were compared between the two groups.Results:The proportion of NSTEMI in AMI was 16.2%in this cohort.The proportion of hypertension(49.0%vs.37.2%,P=0.031),hyperlipidemia(87.5%vs.76.3%,P=0.015)and obesity(49.0%vs.35.8%,P=0.015)were higher in NSTEMI group than in STEMI group.The number of risk factors was also significantly higher in NSTEMI group than in STEMI group([3.2±1.4]vs.[2.8±1.2],P=0.004).The total cholesterol(TC)([4.66±1.50]mmol/L vs.[4.34±1.12]mmol/L,P=0.016),low density lipoprotein cholesterol(LDL-C)([2.88±1.33]mmol/L vs.[2.56±0.97]mmol/L,P=0.006)and glycated hemoglobin(HbA1c)([6.37±1.28]%vs.[6.09±1.19]%,P=0.037])were significantly higher in the NSTEMI group than in the STEMI group.The neutrophils([4.97±1.96]×10^(9)/L vs.[5.50±2.72]×10^(9)/L,P=0.023)and neutrophils/lymphocyte ratio(NLR)([2.36±1.27]vs.[2.81±2.01],P=0.006)were significantly lower in the NSTEMI group than in the STEMI group.The left ventricular ejection fraction was significantly higher in the NSTEMI group than in the STEMI group([61.74±8.02)%vs.(57.55±8.89)%,P<0.001).The ratio of three-vessel/left main lesion was significantly higher in NSTEMI group than in STEMI group(37.5%vs.27.2%,P=0.041).In the NSTEMI group,the proportion of vascular occlusion was 29.2%,and the proportion of left circumflex artery was the highest,accounting for 14.6%.The number of stents implanted was significantly higher in NSTEMI group than in STEMI group([1.95±1.08]vs.[1.60±1.00],P=0.007).Binary logistic regression analysis showed that LDL-C(OR=1.297,P=0.008),and obesity(OR=1.633,P=0.035)were independent risk factors of NSTEMI.Conclusions:Young NSTEMI patients have more risk factors than STEMI patients,more severe coronary artery lesions,more stent implantation.LDL-C and obesity are the independent risk factors of NSTEMI.
作者
张海华
俞梦越
ZHANG Haihua;YU Mengyue(Premium Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第9期914-919,共6页
Chinese Circulation Journal
基金
国家自然科学基金项目(81670415)。
关键词
非ST段抬高型心肌梗死
年轻人群
危险因素
肥胖
non-ST-segment elevation myocardial infarction
young patients
risk factor
obesity
