【摘要】 目的 探讨男性早发冠状动脉粥样硬化性心脏病(冠心病)患者的临床及冠状动脉特点。方法 回顾性分析2010年1月至2011年2月在首都医科大学附属北京安贞医院住院经冠状动脉造影诊断为冠心病并行经皮冠状动脉介入治疗的1 054例男性患者的临床资料。根据冠心病发病年龄将患者分为早发冠心病组(早发组,发病年龄<55岁,414例)和非早发冠心病组(非早发组,发病年龄≥55岁,640例)。采集患者基本信息和心血管危险因素,包括高血压、糖尿病、脑卒中、脂代谢异常、吸烟、饮酒史等,记录患者血糖、血脂、肾功能等生化指标和血红蛋白、血小板计数等血液检测结果,并记录冠状动脉造影结果 和介入治疗信息。分析早发和非早发组心血管病危险因素和冠状动脉病变特点及介入治疗是否存在差异。结果 早发组吸烟、饮酒患者的比例明显高于非早发组,脑卒中的患病比例低于非早发组,差异有统计学意义[(73.2%(303/414)比60.3%(386/640)、30.3%(125/414)比22.5%(144/640)、0.5%(2/414)比10.6%(68/640),P<0.05];早发组血红蛋白、白细胞计数、血小板计数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平高于非早发组[(150±12)g/L比(144±14)g/L、(7.1±1.8)×10~9/L比(6.7±1.7)×10~9/L、(212±57)×10~9/L比(196±54)×10~9/L、(4.3±1.0)mmol/L比(4.1±0.9)mmol/L、(2.4±1.7)mmol/L比(1.7±1.0)mmol/L、(2.6±0.8)mmol/L比(2.4±0.7)mmol/L],高密度脂蛋白胆固醇、尿素氮、肌酐水平低于非早发组[(1.0±0.4)mmol/L比(1.1±0.3)mmol/L、(5.7±1.6)mmol/L比(6.3±2.0)mmol/L、(84±19)μmol/L比(92±60)μmol/L],差异均有统计学意义(均P<0.05)。早发组患者的冠状动脉以单支病变为主比例高于非早发组[47.3%(196/414)比34.1%(218/640)],差异有统计学意义(P<0.05);早发组与非早发组的病变血管均为前降支居多,分别为68.1%(282/414)和72.5%(464/640),差异无统计学意义(P>0.05);早发组病变血管位于右冠状动脉、左主干的比例均低于非早发组,差异有统计学意义[45.4%(188/414)比53.0(339/640)、6.5%(27/414)比12.3%(85/640),P<0.05]。早发组钙化病变、弥漫长病变的发生率低于非早发组,差异均有统计学意义[1.7%(7/414)比4.1%(26/640)、43.5%(180/414)比50.0%(320/640),均P<0.05]。结论 血脂异常、吸烟、血红蛋白以及血小板水平增高是男性早发冠心病的主要危险因素。男性早发冠心病患者冠状动脉以单支病变为主。更多还原

【Abstract】 Objective To investigate the clinical and coronary characteristics in the male patients with premature coronary artery disease.Methods Data of 1 054 consecutive male patients with coronary artery disease confirmed by coronary angiography who underwent percutaneous coronary intervention from January 2010 to February 2011 were retrospectively analyzed.The patients were divided into premature group(pre group,<55 years old,414 cases) and nonpremature group(N-pre group,≥55 years old,640 cases).The baseline demographic data,cardiovascular risk factors(hypertension,diabetes mellitus,dyslipidemia,smoking,drinking,etc),laboratory tests(fasting blood glucose,lipid,blood urea nitrogen,creatinine,hemoglobin,platelet),coronary angiography and intervention data were analyzed and compared between the two groups.Results Compared with N-pre group,pre group had higher proportions of smoking and drinking history and a lower proportion of stroke[73.2%(303/414) vs 60.3%(386/640),30.3%(125/414) vs22.5%(144/640),0.5%(2/414) vs 10.6%(68/640),P<0.05].The levels of hemoglobin,white cell,platelet,serum total cholesterol,triglyceride and low density lipoprotein cholesterol were significantly higher,the levels of serum high density hpoprotein cholesterol,blood urea nitrogen,creatinine were significantly lower in pre group than those in N-pre group[(150 ± 12) g/L vs(144 ± 14) g/L,(7.1 ±1.8) × 10~9/L vs(6.7+1.7) × 10~9/L,(212 ±57) × 10~9/L vs(196 ±54) × 10~9/L,(4.3 ± 1.0) tnmol/L vs(4.1 ±0.9) mmol/L,(2.4 ± 1.7) mmol/L vs(1.7 ± 1.0) mmol/L,(2.6±0.8) mmol/L vs(2.4+0.7) mmol/L,(1.0±0.4) mmol/L vs(1.1 ±0.3) mmol/L,(5.7 ±1.6) mmol/L vs(6.3±2.0) mmol/L,(84±19) μmol/L vs(92±60) μmol/L](allP<0.05).In pre group there were more single vessel diseases compared with N-pre group[47.3%(196/414) vs 34.1%(218/640),P < 0.05];both groups had high rate of target lesions in the left anterior descending coronary artery[68.1%(82/414) vs 72.5%(464/640)]with no significant difference(P >0.05);there was a lower rate of target lesions in the right coronary artery and the left main coronary artery in pre group compared with N-pre group[45.4%(188/414) vs 53.0(339/640),6.5%(27/414)vs 12.3%(85/640),P <0.05].The pre-group had a lower rate of calcification and long diffuse coronary lesion compared with N-pre group[1.7%(7/414) vs 4.1%(26/640),43.5%(180/414) vs 50.0%(320/640),all P <0.05].Conclusions Dyslipidemia,smoking,high level of hemoglobin and platelet are major risk factors of premature coronary artery disease in the male patients.Single vessel disease is common in premature coronary artery disease.更多还原