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目的:比较心肌梗死(MI)患者的特征、处置与病死率在性别方面的差异。方法:收集1998～2004年在贵阳医学院附属医院住院的首次MI患者856例男性和587例女性资料并随访至2005年6月,分析比较MI患者的临床特征、处置与病死率在性别方面的差异。结果:在随访期有351例(41.00%)男性和283例(48.21%)女性死亡。单因素分析显示女性有较高的病死率(风险率1.44,95%CI为1.24～1.67,P<0.01),但经过年龄、吸烟、伴存疾病、心血管病病史、糖尿病、高血压和情感抑郁等多因素调整后无差异(风险率1.01,95%CI为0.87～1.19,P>0.05)。MI后1个月内女性有较高的病死率(风险率1.53,95%CI为1.19～1.96,P<0.01),但经过上述多因素调整后无差异(风险率1.03,95%CI为0.78～1.36,P>0.05)。分析用药的情况发现女性使用他汀类药物比例高(调整后OR=1.47,95%CI为1.09～1.96,P<0.01),而β受体阻滞剂较少(调整后OR=0.77,95%CI为0.59～1.00,P<0.05)。其他2级预防药物及溶栓药物无差异。结论:男、女性在MI预后差别的主要原因在于患者的年龄、处置和多因素的影响,如果女性患者能得到相同的处置,则生存率将与男性相同。
PURPOSE: To compare the gender differences in the characteristics, management and mortality of patients with myocardial infarction (MI). Methods: The data of 856 first-episode MI patients and 587 female MI patients hospitalized in the Affiliated Hospital of Guiyang Medical College from 1998 to 2004 were collected and followed up to June 2005. The clinical characteristics, treatment and mortality of MI patients were compared between the sexes difference. Results: 351 (41.00%) males and 283 (48.21%) females died during the follow-up period. Univariate analysis showed that women had a higher case fatality rate (risk 1.44, 95% CI 1.24-1.67, P <0.01), but after age, smoking, co-morbidity, history of cardiovascular disease, diabetes mellitus, hypertension, and emotional Depression and other factors were no differences after adjustment (risk rate 1.01, 95% CI 0.87 to 1.19, P> 0.05). Women had a higher case fatality rate within 1 month after MI (risk ratio 1.53, 95% CI 1.19 to 1.96, P <0.01), but no difference after adjustment for the above factors (risk ratio 1.03, 95% CI 0.78 ~ 1.36, P> 0.05). Analysis of the use of drugs found that the proportion of women using statins is high (adjusted OR = 1.47,95% CI 1.09 to 1.96, P <0.01), and less beta blockers (adjusted OR = 0.77,95% CI 0.59 ~ 1.00, P <0.05). No other grade 2 prophylaxis and thrombolytic drugs. CONCLUSIONS: The main reason for the difference in the prognosis of MI between men and women is the patient’s age, management and multivariate effects. The same survival rate will be obtained in women if they receive the same treatment.