不同年龄段急性心肌梗死患者冠脉病变情况及临床特征分析

目的 分析不同年龄段急性心肌梗死（AMI）患者的冠脉病变情况及临床特征，为AMI的治疗和预防提供依据。方法 回顾性分析天津医科大学第二医院2011年1月—2017年12月收治的547例AMI（包括STEMI和NSTEMI）患者的病例资料，根据年龄分为青年组（18~65岁，213例）、中年组（66~79岁，176例）和老年组（80~99岁，158例）。比较三组患者病史、实验室检查、Gensini评分、梗死部位及病变血管情况。结果 547例急性心梗患者，平均年龄68.5±12.8岁，青年组女性所占比例在三组中最少（P＜0.01），老年组吸烟率最低，且中年组低于青年组（P＜0.01）。三组患者糖尿病和高血压病史占比差异无统计学意义（P＞0.05）。实验室指标中，三组患者血尿素氮（BUN）、天冬氨酸转移酶（AST）、白细胞（WBC）、中性粒细胞百分比（NEU）、红细胞（RBC）、血红蛋白（Hb）、血小板（PLT）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、总甘油三酯（TG）、总胆固醇（TC）比较，差异有统计学意义（P＜0.01）；血肌酐（SCr）、丙氨酸转移酶（ALT）比较，差异无统计学意义（P＞0.05）。Gensini评分老年组高于其余两组，且老年组评分大于80分的患者明显多余于青年组和中年组（P＜0.01），但青年组和中年组之间差异无统计学意义（P＞0.0167）。青年组多为单支或2支冠脉血管病变，中年组和老年组多为多支血管病变。梗死部位比较，三组均为前壁和下壁梗死居多，前壁和后壁梗死占比差异有统计学意义（P＜0.01），下壁、侧壁和右室梗死三组无显著差异（P＞0.05）。结论 不同年龄段急性心肌梗死患者冠脉病变情况和临床特征存在一定的差异，应针对各年龄段心梗患者的特点和具体病情，选择合适的预防和治疗手段，以期患者获得最大程度受益。

Analysis on coronary lesions and clinical characteristics of acute myocardial infarction in patients of different ages

Objective To analyze the coronary lesions and clinical features in AMI(both STEMI and NSTEMI) patients among different age groups. Methods The clinical data of 547 patients with AMI who admitted in the Second Hospital of Tianjin Medical University during January 2011 to December 2017 were retrospectively analyzed. The patients were divided into youth group (18 to 65 years old, n=176), middle-aged group (66-79 years old, n=176) and old group (80 to 99 years old, n=158). General information, laboratory examination results, Gensini score, infarction areas and coronary artery lesions were compared among three groups. Results The average age of 547 AMI inpatients enrolled was 68.5±12.8 years old. Women in the youth group were the least in the three groups（P＜0.01）. And the smoking rate of the old group was the lowest, while the middle-aged group was lower than that of the youth group（P＜0.01）. And there was no significant difference in the proportion of diabetes mellitus and hypertension among three groups（P＞0.05）. There was statistically significant difference in BUN, AST, WBC, NEU, RBC, Hb, PLT, LDL, HDL, TG and TC in the three groups, respectively(P＜0.01), while there was no statistically significant difference in SCr and ALT（P＞0.05）. The Gensini score was higher in the old group than in the other two groups, and the elderly with a score of more than 80 points were significantly richer than the youth and middle-aged groups（P＜0.01）, but the difference between the latter two groups was not statistically significant（P＞0.0167）. Most of patients in youth group were single vessel or two vessels disease, while middle-aged group and the old group were mostly multivessel disease. There was significant difference in the proportion of anterior wall and posterior wall infarction among the three groups（P＜0.01）, but there was no significant difference in inferior wall, lateral wall and right ventricular infarction（P＞0.05）. Conclusion There is significant difference in coronary lesions and clinical features of patients with acute myocardial infarction in different ages. And appropriate prevention and treatment should be selected for patients with myocardial infarction in different ages.