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目的探讨早发冠心病患者的危险因素、临床症状和冠状动脉病变特点的性别差异。方法连续入选我科2009年5月~2014年10月经冠脉造影确诊的198例早发冠心病患者,分为男性组(年龄<55岁,n=135)和女性组(年龄<65岁,n=63)。观察两组在冠心病危险因素、临床症状和冠脉造影特点等方面的差异,探讨早发冠心病患者的性别特征。结果男性组吸烟(83%vs.5%,P<0.01)、肥胖(28%vs.16%,P<0.05)和饮酒的比例(39%vs.2%,P<0.01)显著高于女性组,而女性组高血压病患者的比例高于男性组(70%vs.51%,P<0.05);两组糖尿病、血脂异常患者的比例之间差别无统计学意义。男性组血清三酰甘油水平较女性组高〔(2.0±1.4)mmol/L vs.(1.6±0.9)mmol/L,P<0.05〕,而高密度脂蛋白胆固醇〔(1.03±0.23)mmol/L vs.(1.18±0.27)mmol/L,P<0.01〕和载脂蛋白A水平〔(1.11±0.19)g/L vs.(1.20±0.23)g/L,P<0.01〕和载脂蛋白A/B比值〔(1.4±0.5)vs.(1.6±0.5),P<0.01〕则均较女性组低。男性组危险因素聚集较女性组明显〔(1.9±1.0)vs.(1.1±0.8),P<0.01〕;职业分布中,工人在两组所占比例均较高(50%vs.40%),但男女组间无显著差异。与男性组比较,女性下岗或无业比例较更高(12%vs.30%,P<0.01);两组无胸痛比例(35%vs.46%)无显著差异,同时,男性患者出汗较为常见(44%vs.29%,P<0.05),而女性组心悸现象则较多见(7%vs.22%,P<0.01)。两组冠状动脉造影结果显示均以单支病变为主(49%vs.60%),病变血管均以前降支最为多见(68%vs.54%)。两组冠状动脉造影结果比较,病变血管数、罪犯血管分布和累及植入支架比例之间差别均无统计学意义。结论早发冠心病患者临床特征存在性别差异,但冠状动脉病变分布特征二者之间无显著差别。
Objective To investigate the gender differences of risk factors, clinical symptoms and coronary lesions in patients with premature coronary artery disease. Methods A total of 198 patients with premature coronary artery disease diagnosed by coronary angiography from May 2009 to October 2014 were enrolled and divided into male group (age <55 years, n = 135) and female group (aged <65 years old, n = 63). The differences between the two groups in the risk factors of coronary heart disease, clinical symptoms and coronary angiography were observed, and the gender characteristics of patients with premature coronary heart disease were investigated. Results In the male group, smoking (83% vs.5%, P <0.01), obesity (28% vs.16%, P <0.05) and alcohol consumption (39% vs.2%, P <0.01) (70% vs.51%, P <0.05). There was no significant difference between the two groups in the proportion of patients with diabetes and dyslipidemia. Serum triglyceride levels were significantly higher in men than in women [(2.0 ± 1.4) mmol / L vs. (1.6 ± 0.9) mmol / L, P <0.05) (1.11 ± 0.19) g / L vs. (1.20 ± 0.23) g / L, P <0.01, respectively) and LPS (1.18 ± 0.27 mmol / L, P <0.01) and apolipoprotein A The ratio of A / B [(1.4 ± 0.5) vs. (1.6 ± 0.5), P <0.01] was lower in women than in women. The risk factors in male group were significantly higher than those in female group [(1.9 ± 1.0) vs. (1.1 ± 0.8), P <0.01]. Occupational distribution had a higher proportion of workers in both groups (50% vs. 40% , But there was no significant difference between men and women. Compared with the male group, the proportion of women laid off or unemployed was higher (12% vs. 30%, P <0.01). There was no significant difference between the two groups (35% vs.46%), while the male patients had more (44% vs.29%, P <0.05), while palpitations were more common in women (7% vs.22%, P <0.01). Coronary angiography showed that the lesions were predominantly single (49% vs.60%) in both groups, with the most common anterior descending branch of the lesion (68% vs.54%). There was no significant difference between the two groups in coronary angiography, the number of vascular lesions, the distribution of culprit vessels and the proportion of implanted stent. Conclusion There are gender differences in the clinical features of patients with premature coronary heart disease, but there is no significant difference between the two.