【摘要】 目的 探讨不同年龄段急性心肌梗死患者的临床特征、预后差异，并分析不良心脑血管事件危险因素及性别差异。方法 选择2018年3月至2021年3月沧州市中心医院收治的336例急性心肌梗死患者为研究对象。根据年龄将患者分为年轻组(n=123，年龄≤45岁)和中老年组(n=213，年龄> 45岁)。比较2组患者的临床特点、预后情况的差异，采用Cox回归分析不良心脑血管事件发生的影响因素，并分析危险因素的性别差异。结果 2组患者的性别、体质量指数、吸烟史、高血压病史、糖尿病病史、高血脂病史、冠心病病史、脑血管病史、典型胸痛占比、Killip分级、造影特点、白细胞计数、血小板计数、红细胞压积及血红蛋白、肌酐、三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、N末端B型钠尿肽前体水平比较差异均有统计学意义(P<0.05)。年轻组患者院内病死率、不良心脑血管事件发生率显著低于中老年组(P<0.05); 2组患者院内死亡原因以及院内并发症发生率比较差异均无统计学意义(P >0.05)。年龄(中老年)、性别(女)、Killip分级(Ⅲ～Ⅳ级)、造影特点(多支冠状动脉病变)是急性心肌梗死患者不良心脑血管事件发生的影响因素(P<0.05);且Killip分级(Ⅲ～Ⅳ级)、造影特点(多支冠状动脉病变)均是男性、女性急性心肌梗死患者不良心脑血管事件发生影响因素(P<0.05)。结论 年轻(≤45岁)急性心肌梗死患者多见于男性，常伴有高脂血症、吸烟史及单支冠状动脉病变，整体预后优于中老年患者;中老年患者(> 45岁)多合并高血压、糖尿病、冠心病等基础疾病，冠状动脉病变更为复杂和严重(多支冠状动脉病变多见)，整体预后较差。而高龄、女性、高Killip分级及多支冠状动脉病变是预后不良的独立危险因素，上述因素在男女患者中均显著相关。更多还原

【Abstract】 Objective To investigate the clinical characteristics and prognostic differences among acute myocardial infarction patients with different age groups,and analyse the gender differences of risk factors for adverse cardiovascular and cerebrovascular events. Methods A total of 336 patients with acute myocardial infarction admitted to Cangzhou Central Hospital from March 2018 to March 2021 were selected as the study subjects. Patients were divided into young group( n = 123,age≤45 years) and middle-aged and elderly group( n = 213,age > 45 years) based on age. Differences in clinical features and prognosis of patient were compared between the two groups. The factors influencing adverse cardiovascular and cerebrovascular events was analysed by Cox regression analysis,and gender differences in risk factors were analysed. Results There were significant difference in gender,body mass index,smoking history,history of hypertension,history of diabetes,history of hyperlipidemia,history of coronary heart disease,history of cerebrovascular disease,proportion of typical chest pain,Killip classification,angiographic characteristics,white blood cell count,platelet count,hematocrit and hemoglobin,creatinine,triglycerides,total cholesterol,high-density lipoprotein,low-density lipoprotein,and N-terminal pro-B-type natriuretic peptide levels of patients between the two groups( P < 0. 05). The in-hospital mortality rate and incidence of adverse cardiovascular and cerebrovascular events of patients in the young group were significantly lower than those in the middle-aged and elderly group( P < 0. 05); there was no statistically significant differences in the causes of in-hospital death and the incidence of in-hospital complications of patients between the two groups( P > 0. 05). Multivariate Cox regression analysis showed that age( middle-aged and elderly),gender( female),Killip classification( Ⅲ-Ⅳ),and angiographic characteristics( multivessel coronary artery disease) were factors influencing the occurrence of adverse cardiovascular and cerebrovascular events in patients with acute myocardial infarction( P < 0. 05). Additionally,Killip class( Ⅲ-Ⅳ) and angiographic features( multivessel coronary artery disease) were factors influencing adverse cardiovascular and cerebrovascular events in both male and female acute myocardial infarction patients( P < 0. 05). Conclusion Younger( ≤45 years old) acute myocardial infarction patients were mainly male,often accompanied by hyperlipidemia,smoking,and single-vessel disease; and their overall prognosis is better than middle-aged and elderly patients. Middle-aged and elderly patients( > 45 years old) are more complicated with hypertension,diabetes,coronary heart disease and other basic diseases. Coronary artery disease is more complex and serious( multi vessel disease is more common) and the overall prognosis is poor. However,advanced age,female gender,high Killip grade,and multivessel disease are independent risk factors for poor prognosis,and these factors are significantly correlated in both male and female patients.更多还原