发病年龄≤30岁的STEMI患者的临床及冠状动脉病变特征
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摘要
目的探讨发病年龄≤30岁的ST段抬高型心肌梗死(STEMI)患者的临床及冠状动脉(冠脉)病变特征。方法选自西安交通大学第一附属医院于2008年1月至2018年2月确诊的STEMI患者中,选择发病年龄≤30岁的STEMI患者56例,作为观察组。选择同期年龄、性别匹配但排除冠心病的患者51例,作为对照组。两组之间进行冠脉粥样硬化性心脏病(冠心病)危险因素的比较;同时分析观察组患者冠状动脉造影结果。结果观察组56例患者中,6例STEMI患者为非动脉粥样硬化斑块所致心肌梗死,其余50例STEMI患者为冠脉粥样硬化斑块所致,作为实际观察组。与对照组相比,实际观察组具有更高的吸烟比例(P=0.011)和高脂血症比例(P=0.016),高血压病史、糖尿病史、慢性肾脏病史、冠心病家族史在两组之间无统计学差异;与对照组相比,实际观察组血小板计数(P=0.013)和血清同型半胱氨酸水平(P=0.010)更高。实际观察组中,38例患者(76%)冠脉造影为单支病变或未见明确病变,23例患者(46%)经抽吸血栓、充分抗栓治疗后狭窄程度小于70%,无需支架干预;结论传统危险因素,尤其是吸烟和高脂血症,是30岁及以下STEMI患者的主要危险因素;冠状动脉造影多为单支病变,血栓负荷重,斑块负荷轻;治疗策略以恢复血流、抗栓、稳斑为重,部分患者可无需冠状动脉支架治疗;改善不良生活方式和饮食习惯是避免早发心梗的重要措施。
Objective To investigate the clinical and coronary lesion characteristics of patients with STsegment elevation myocardial infarction(STEMI) with an onset age of ≤30 years. Methods From STEMI patients diagnosed between January 2008 and February 2018 in the First Affiliated Hospital of Xi'an Jiaotong University,56 patients with STEMI who had an onset age of ≤30 years were selected as the observation group. A total of 51 patients with age-matched and gender-matched but excluded coronary heart disease were selected as the control group. Coronary heart disease risk factors were compared between the two groups; coronary angiography results were also analyzed in the observation group. Results Of the 56 patients in the observation group, 6 patients with STEMI were non-atherosclerotic plaque-induced myocardial infarction, and the remaining 50 patients with STEMI were caused by coronary atherosclerotic plaque as the actual observation group. Compared with the control group, the actual observation group had a higher proportion of smoking(P=0.011) and a proportion of hyperlipidemia(P=0.016).There were no statistically significant differences between the two groups in the history of hypertension, history of diabetes, history of chronic kidney disease, and family history of coronary heart disease. Compared with the control group, the actual observed group platelet count(P=0.013) and serum homocysteine level(P=0.010) were higher.In the actual observation group, 38 patients(76%) had a single-vessel disease or no clear lesions, and 23 patients(46%) had a stenosis of less than 70% after aspiration thrombolysis and adequate antithrombotic therapy, no stent intervention is required. Conclusions Traditional risk factors, especially smoking and hyperlipidemia, are the main risk factors for STEMI patients aged 30 years and younger; coronary angiography is mostly single-vessel disease,heavy thrombus load, and plaque load is light; treatment strategy to restore blood flow, Antithrombotic and stable plaques are heavy, and some patients can be treated without coronary stents; improving unhealthy lifestyles and eating habits is an important measure to avoid early onset of myocardial infarction.
Objective To investigate the clinical and coronary lesion characteristics of patients with STsegment elevation myocardial infarction(STEMI) with an onset age of ≤30 years. Methods From STEMI patients diagnosed between January 2008 and February 2018 in the First Affiliated Hospital of Xi'an Jiaotong University,56 patients with STEMI who had an onset age of ≤30 years were selected as the observation group. A total of 51 patients with age-matched and gender-matched but excluded coronary heart disease were selected as the control group. Coronary heart disease risk factors were compared between the two groups; coronary angiography results were also analyzed in the observation group. Results Of the 56 patients in the observation group, 6 patients with STEMI were non-atherosclerotic plaque-induced myocardial infarction, and the remaining 50 patients with STEMI were caused by coronary atherosclerotic plaque as the actual observation group. Compared with the control group, the actual observation group had a higher proportion of smoking(P=0.011) and a proportion of hyperlipidemia(P=0.016).There were no statistically significant differences between the two groups in the history of hypertension, history of diabetes, history of chronic kidney disease, and family history of coronary heart disease. Compared with the control group, the actual observed group platelet count(P=0.013) and serum homocysteine level(P=0.010) were higher.In the actual observation group, 38 patients(76%) had a single-vessel disease or no clear lesions, and 23 patients(46%) had a stenosis of less than 70% after aspiration thrombolysis and adequate antithrombotic therapy, no stent intervention is required. Conclusions Traditional risk factors, especially smoking and hyperlipidemia, are the main risk factors for STEMI patients aged 30 years and younger; coronary angiography is mostly single-vessel disease,heavy thrombus load, and plaque load is light; treatment strategy to restore blood flow, Antithrombotic and stable plaques are heavy, and some patients can be treated without coronary stents; improving unhealthy lifestyles and eating habits is an important measure to avoid early onset of myocardial infarction.
引文
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[2]Pineda J,Marin F,Marco P,et al.Premature coronary artery disease in young(age<45)subjects:interactions of lipid profile,thrombophilic and haemostatic markers[J].International Journal of Cardiology,2009,136(2):222-5.
[3]王贺滋,韩雅玲,荆全民,等.青年冠心病危险因素与冠状动脉病变程度的相关性分析[J].解放军医学杂志,2011,(4):331-5.
[4]周亮,叶显华,鲁明,等.早发冠心病患者冠脉病变特征及介入术后预后随访分析[J].浙江临床医学,2018,(2):223-5.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,43(5):380-93.
[6]Marti-Carvajal AJ,Sola I,Lathyris D,et al.Homocysteine-lowering interventions for preventing cardiovascular events[J].Cochrane Database systematic reviews,2017,8:CD006612.
[7]宋艳东,陶英,王苏,等.冠心病患者同型半胱氨酸、血尿酸水平与冠脉病变的相关性[J].中华急诊医学杂志,2017,(4):430-3.
[8]Ma Y,Peng D,Liu C,et al.Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases[J].BMCCardiovascular Disorders,2017,17(1):37.
[9]Liu Y,Tian T,Zhang H,et al.The effect of homocysteine-lowering therapy with folic acid on flow-mediated vasodilation in patients with coronary artery disease:a meta-analysis of randomized controlled trials[J].Atherosclerosis,2014,235(1):31-5.
[10]Li T,Yu B,Liu Z,et al.Homocysteine directly interacts and activates the angiotensin II type I receptor to aggravate vascular injury[J].Nature Communications,2018,9(1):11.
[11]张志世,王凌燕.同型半胱氨酸与冠心病[J].中国循环杂志,2016,(4):405-7.
[12]Kounis NG,Hahalis G.Serum IgE levels in coronary artery disease[J].Atherosclerosis,2016,251:498-500.
[13]Guo X,Yuan S,Liu Y,et al.Serum IgE levels are associated with coronary artery disease severity[J].Atherosclerosis,2016,251:355-60.
[14]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,(5):382-400.
[2]Pineda J,Marin F,Marco P,et al.Premature coronary artery disease in young(age<45)subjects:interactions of lipid profile,thrombophilic and haemostatic markers[J].International Journal of Cardiology,2009,136(2):222-5.
[3]王贺滋,韩雅玲,荆全民,等.青年冠心病危险因素与冠状动脉病变程度的相关性分析[J].解放军医学杂志,2011,(4):331-5.
[4]周亮,叶显华,鲁明,等.早发冠心病患者冠脉病变特征及介入术后预后随访分析[J].浙江临床医学,2018,(2):223-5.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,43(5):380-93.
[6]Marti-Carvajal AJ,Sola I,Lathyris D,et al.Homocysteine-lowering interventions for preventing cardiovascular events[J].Cochrane Database systematic reviews,2017,8:CD006612.
[7]宋艳东,陶英,王苏,等.冠心病患者同型半胱氨酸、血尿酸水平与冠脉病变的相关性[J].中华急诊医学杂志,2017,(4):430-3.
[8]Ma Y,Peng D,Liu C,et al.Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases[J].BMCCardiovascular Disorders,2017,17(1):37.
[9]Liu Y,Tian T,Zhang H,et al.The effect of homocysteine-lowering therapy with folic acid on flow-mediated vasodilation in patients with coronary artery disease:a meta-analysis of randomized controlled trials[J].Atherosclerosis,2014,235(1):31-5.
[10]Li T,Yu B,Liu Z,et al.Homocysteine directly interacts and activates the angiotensin II type I receptor to aggravate vascular injury[J].Nature Communications,2018,9(1):11.
[11]张志世,王凌燕.同型半胱氨酸与冠心病[J].中国循环杂志,2016,(4):405-7.
[12]Kounis NG,Hahalis G.Serum IgE levels in coronary artery disease[J].Atherosclerosis,2016,251:498-500.
[13]Guo X,Yuan S,Liu Y,et al.Serum IgE levels are associated with coronary artery disease severity[J].Atherosclerosis,2016,251:355-60.
[14]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,(5):382-400.