老年與青年急性心肌梗死患者相關因素的分析

蔡小婕+江隆福

[摘 要] 目的 探討急性心肌梗死（AMI）45歲以下患者和60歲以

上患者的危險因素和臨床特點?

方法 將確診為AMI<45歲的68例患者（青年組）與>60歲的171例患者（老

年組）進行對照研究，分析其危險因素?冠狀動脈病變和30天不良事件率等特點?

結果 青年組男性比例?吸煙者和高脂血癥者較老年組多，而青年組糖尿

病?高血壓和慢性腎功能不全低于老年組，差異均有統計學意義（P<0.01）?老年組發

生30天不良事件高于青年組（P<0.05）

?老年組和青年組30天不良事件發生組Killip分級≥3級和多支病變者更多，而LVEF值則更

低?老年組中，30天不良事件發生組糖尿病者比例?高脂血癥者比例?CKMB高峰值水平皆

高于未發生組?

結論 吸煙?高脂血癥和性別為青年AMI的主要危險因素，而老年AMI則較

多合并高血壓?糖尿病和慢性腎功能不全?killip分級?冠狀動脈病變的嚴重程度和左心室

收縮功能仍為影響預后的重要因素?

[關鍵詞] 心肌梗死；老年；青年；相關因素

中圖分類號：R542.2+2

文獻標識碼：A 文章編號：1009_816X

（2014）01_0016_03

doi：10.3969/j.issn.1009_816x.2014.01.07

Analysis on Related Factors among Young and Elderly Patients with Acute Myocardi

al Infarction.

CAI Xiao_jie， JIANG Long_fu. The Second Hospital of Ningbo City， Zhejiang 3150

10， China

[Abstract] Objective To explore the risk factors and clinical

features of acute myocardial infarction （AMI） among young and elderly patients.

Methods

A case_control study was conducted involving 68 young patients （<45） an

d 171 elderly patients （>60） with clinical diagnosis of AMI. The differences of

risk factors， clinical characteristics were analyzed between the two groups.

Results

Compared with the group with elderly patients， the risk factors of smoking and h

ypercholestero

lemia were more frequently found among the young patients（P<0.01）， but the

rates

of hypertension? diabetes and chronic kidney disease were lower（P<0.01）

. AMl pa

tients of male were more for youth than for elderly （P<0.01） .The 30_day m

ajor a

dverse clinical outcome （MACO） was significantly lower in the young patients tha

n in the elderly patients （P<0.05）. Either young or elderly AMI patients，

the

incidence of an advanced Killip score （defined as ≥ score 3 upon presentation）

and multiple vessel disease were significantly higher in group with 30_day MACO

than in group without 30_day MACO， whereas left ventricular ejection fraction（LV

EF） were significantly lower. In the elderly AMI patients， the rates of diabete

s

? hyperlipidaemia and peak CKMB level were significantly higher in group with 3

0_day MACO than in group without 30_day MACO.

Conclusions Smoking， hypercholestero

lemia and gender are the major risk factors for AMI among individuals below theendprint

age of 45. Elderly AMI patients mostly combined with hypertension， diabetes and

chronic kidney disease. Advanced Killip score， the severity of coronary artery

disease and LVEF are the important factors for prognosis.

[Key words] Myocardial infarction； Elderly patients； Young pat

ients； Related factors

近年來，冠心病急性心肌梗死（AMI）發病呈現年輕化的趨勢?1978年Bergsrand[1]

等報道小于40歲的AMI患者占所有患者的6%左右?而2004年Saleheen[2]等報道45

歲以下的

AMI占所有AMI的16%左右?可見年輕的急性心肌梗死患者明顯增多?他們與老年患者在危

險因素和預后等方面有何不同，目前仍未完全明確?本文旨在通過回顧性分析比較45歲以下

AMI青年患者和老年患者的臨床特點，為急性心肌梗死的治療和預防提供依據?

1 資料和方法〖JP2〗

1.1 一般資料：選取2007年1月至2012年12月在我院收治的首次發生AMI患者，且符合以下