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摘要: 目的：研究急性冠状动脉综合征（ACS）患者危险因素的性别差异，为不同性别冠心病患者的临床防治工作提供理论依据。方法：选取2012-03-2014-01在大连医科大学附属二医院心内科住院治疗，符合ACS诊断标准并经过冠脉造影及冠脉支架植入术的1 269例患者，收集患者基本资料、相关病史及血管造影结果，按性别、年龄血脂水平分组，对其冠心病危险因素、血脂水平、冠状动脉病变特点进行统计学分析。结果：女性ACS患者的平均年龄为（68.0±8.5）岁，男性（62.3±11.2）岁，女性的发病年龄晚于男性（P<0.05）；ACS伴高血压和糖尿病的女性患者多于男性患者，而有吸烟史的男性明显多于女性（P<0.05）；女性患者总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、Apo-a、Apo-b、非高密度脂蛋白胆固醇（non-HDL-C）的平均值均高于男性患者（P<0.05），LDL-C/HDL-C比值与之相反（P<0.05）；女性ACS患者HDL-C水平正常的比例均高于同龄组男性，男性HDL-C降低的比例显著高于女性（P<0.05），而HDL-C水平与冠脉病变严重程度的无明显相关性（P>0.05）；年龄>55岁患者中non-HDL-C<3.37 mmol/L组和non-HDL-C ≥ 3.37 mmol/L组有显著性别差异（P<0.05），而年龄≤ 55岁患者无此差异（P>0.05），non-HDL-C水平与冠脉病变严重程度的相关性亦无明显性别差异（P>0.05）。结论：年龄≤ 55岁的女性ACS发病率低于同龄组男性，当年龄>55岁时，女性ACS的发病率显著升高；高血压病和糖尿病对女性ACS患者的影响高于男性，而吸烟史对男性ACS患者的影响则高于女性，家族史和体重指数无明显性别差异；ACS患者血脂紊乱存在性别差异；HDL-C和non-HDL-C水平与冠状动脉病变严重程度的相关性无明显性别差异。Abstract: Objective: To provide a theoretical basis for clinical prevention and treatment of coronary heart disease in patients with different gender by analyzing the gender differences in patients with risk factors of acute coronary syndrome (ACS).Method: The clinical data and angiographic results about 1 269 patients who were diagnosed as ACS after coronary angiography and received coronary stent implantation were collected in the Department of Cardiology of the Second Affiliated Hospital of Dalian Medical University from March 2012 to January 2014. The patients were grouped by gender, age and blood lipid levels. The traditional CHD risk factors (including age, smoking, blood pressure, blood glucose, BMI, family history) and coronary angiographic changes of these patients were statistically analyzed and compared among different gender.Result: The average age of the female patients with ACS was(68.0±8.5) years old and that of the male patients is (62.3±11.2) years old, so the women's onset age of ACS was younger than men's(P<0.05). The incidence of female patients with hypertension and diabetes was higher than male patients, and the proportion of male patients with a smoking history was significantly higher than women (P<0.05).The average lipid level of TC, LDL-C, HDL-C, Apo-a, Apo-b and non-HDL-C of female patients was higher than that of male patients, but LDL-C/HDL-C was lower than that of male patients(P<0.05). The proportion of normal HDL-C level both in the middle-aged and elder-aged group of women was higher than that of men, and the proportion of men's lower HDL-C level was higher than that of women's(P<0.05).There was no gender difference in correlation of high-density lipoprotein cholesterol (HDL-C) and coronary artery lesions (P>0.05). In the ACS patients age >55, there were significant gender differences between non-HDL-C<3.37 mmol/L group and non-HDL-C ≥ 3.37 mmol/L group. But not in the ACS patients age ≤ 55(P>0.05), there was no difference in correlation of non-HDL-C and coronary artery lesions (P>0.05).Conclusion: The ACS incidence of women age ≤ 55 is lower than that in the same-aged men, but that of women age > 55 significantly increases. The affect of hypertension and diabetes for women is larger than that for men, but the effect of smoking history for men is larger than that for women. There is no gender difference between positive CHD family history and body mass index on the influence of ACS. In the ACS patients, there are significant gender differences on blood lipid level. There is a good correlation in effects on coronary artery vascular lesions of both HDL-C and non-HDL-C, but the correlation has no gender differences.
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Key words:
- Acute coronary syndrome /
- Risk factors /
- Lipid /
- Sex
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