中青年和老年冠心病的临床特点及危险因素比较分析(1)
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【摘要】 目的 探讨中青年和老年冠心病患者的临床特点及其危险因素。方法 将冠心病患者228例,按年龄分为中青年组46例(≤50岁)和老年组182例(≥60岁)。所有患者均有完整的病历资料和冠状动脉造影结果,调查既往史,测定空腹血糖、血脂等生化指标,比较初发症状、冠状动脉病变支数、并发症及危险因素等方面的差异。结果 中青年组男性、吸烟、饮酒、高血脂、家族史及具有典型心绞痛症状的患者均高于老年组(均P<0.01);高血压、糖尿病低于老年组 (均P<0.01);冠状动脉病变中青年组以单支病变为主,而老年组以多支病变居多(P<0.01);并发症以老年组较多。结论 中青年组冠心病患者具有症状典型且有明显诱发因素、并发症少、以单支冠脉病变为主的特点,老年组患者的临床特点是症状多样化和不典型、并发症及并存病多、易误诊和漏诊。男性、吸烟、饮酒、高血脂症、冠心病家族史是中青年患者的主要危险因素,高血压和糖尿病则是老年患者的危险因素。有效地干预危险因素,是冠心病防治的关键。
【关键词】 冠心病;临床特点;危险因素;中青年人;老年人
Clinical characteristics and risk factors analysis of middle-aged and young, elderly patients with coronary artery disease
ZHONG Dong.Department of Cardiology,The First People’s Hospital of Fangcheng City, Fangcheng, Guangxi 538021,China
【Abstract】 Objective To investigate the clinical characteristics and risk factors of middle-aged and young, elderly patients with coronary artery disease.Methods 228 cases with coronary artery disease were divided into middle-aged and young group(46 cases, ≤50 years) and elderly group(182 cases, ≥60 years).The disease history, fasting blood glucose, blood fat, initial symptom, extent of coronary artery disease,complication and risk factors of two groups were compared.Results The patients of male,smoking,drinking, hyperlipemia, family history and with typical sternalgia symptom in middle-aged and young group were more compared wit elderly group(all P<0.01);the amount of patients with hypertension and diabetes in middle-aged and young group was less significantly compared with elderly group(P<0.01);more single-vessel lesion was found in middle-aged and young patients than that in elderly group,while multiple vessel lesion was just the reverse;the complications were more in elderly group.Conclusion With typical symptom, obvious causative factor,less complication andsingle-vessel lesion are clinical characteristics of middle-aged and young patients,while clinical characteristics of edlerly patients are reversed.Male,smoking,drinking, hyperlipemia, family history of coronary artery disease are main risk factors of middle-aged and young patients, hypertension and diabetes are risk factors of elderly patients.Effective different prevent measures should be adopted in different aged patients with different clinical and damaged coronary arterial characteristics.
【Key words】 Coronary artery disease;Clinical characteristics;Risk factor;Middle-aged and young;Aged
近年来,随着社会的发展和人们生活水平的提高,冠状动脉性心脏病(冠心病)发病率逐渐升高,是人们生命健康的“第一杀手”[1]。因此,了解中青年和老年冠心病的临床特点,干预或控制发生冠心病的危险因素,对于有效防治冠心病,提高中青年和老年人的身体健康非常重要。笔者比较分析了50岁以下和60岁以上冠心病患者的临床特点及危险因素,现报告如下。
1 资料与方法
1.1 一般资料 本组228例系本院2001年1月至2009年6月心内科门诊或住院患者,均符合文献[1]诊断标准。50岁以下46例,其中男40例,女6例,男∶女约为6.7∶1;年龄26～50岁,平均(41.5±2.5)岁。60岁以上182例,其中男98例,女84例,男∶女约为1.2∶1;年龄60～85岁,平均(69.5±5.5)岁。本组患者均有完整的病历资料和冠状动脉造影结果(广西医科大学第一附属医院或广西壮族自治区人民医院冠状动脉造影检查)。
1.2 方法 调查每例患者的危险因素、典型的心绞痛症状及冠脉造影结果。危险因素着重调查高血压、糖尿病、吸烟、饮酒、高血脂及家族史,一级亲属患冠心病或高血压为家族史阳性。禁食12 h清晨空腹抽取前臂静脉血,测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹葡萄糖(FBG)水平,进行心脏超声检查。
1.3 统计学方法 采用SPSS 11.0软件进行数据分析,计数资料组间比较采用χ2检验,计量资料组间比较采用t检验,以P<0.05为差异有统计学意义。
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