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目的:探讨不同年龄组急性冠状动脉综合征(ACS)住院患者的危险因素、冠状动脉病变特点及预后。方法:选择BRIG基线资料中,接受导管检查的963例患者,将其按年龄分组分为5组,<45岁组83例、45~54岁组194例、55~64岁组281例、65~74岁组290例、>75岁组115例,回顾性分析其危险因素、冠状动脉病变特点及住院期间主要不良心脑血管事件(MACCE)发生率及药物的临床应用情况。结果:①ACS患者中以男性为主(男女之比76.5%∶23.5%,P<0.01),其中女性患者比例随年龄增加而逐渐增高,<45岁组与45~54岁组差异有统计学意义(P<0.05),>55岁的3组与<55岁的2组之间差异均有统计学意义(P<0.01)。②年龄<45岁组与45~54岁组患者多与吸烟、冠心病家族史有关,其余3组与高血压、糖尿病有关。③>75岁组患者中血肌酐明显升高,并且与其他各组间差异有统计学意义(P<0.01);血尿酸也升高,与45~54岁组、55~64岁组差异有统计学意义(P<0.05,P<0.01)。④冠状动脉病变支数随年龄增加而增加,年龄<45岁组以单支病变为主,与其余4组差异均有统计学意义(P<0.01);65~74岁组及>75岁组患者以3支病变为主,与其他3组差异均有统计学意义(P<0.01)。⑤病变类型、血运重建成功率各组间差异无统计学意义(P>0.05)。⑥不同年龄组患者用药情况:β-受体阻滞剂在年龄<45岁组和55~64岁组患者与65~74岁组及>75岁组患者存在差异(P<0.05);低分子量肝素在45~54岁组患者与65~74岁组患者存在差异(P<0.05);阿司匹林、ACEI/ARB和他汀类调脂药应用无差异(P>0.05);⑦不同年龄组患者住院期间主要事件的发生率或再发心肌梗死联合事件发生率均无差异(P>0.05);但死亡有差异(P<0.01)。Logist多因素回归分析发现,除年龄外,肾功能下降(P<0.01)是独立危险因素。结论:不同年齢组ACS患者的危险因素及冠状动脉病变有不同的特点,除综合干预危险因素外,应针对不同年龄组ACS患者的冠状动脉病变特点采取相应的干预措施。
Objective: To investigate the risk factors of inpatients with acute coronary syndrome (ACS) in different age groups, the characteristics and prognosis of coronary lesions. METHODS: A total of 963 patients undergoing catheterization in the baseline data of the BRIG were divided into 5 groups according to age, 83 in the 45-year-old group, 194 in the 45 to 54-year-old group, 281 in the 55 to 64-year-old group, A total of 290 patients aged ~ 74 years and 115 patients aged> 75 years were enrolled in this study. The risk factors, the characteristics of coronary lesions and the incidence of major adverse cardiovascular events (MACCE) during hospitalization and the clinical application of the drugs were retrospectively analyzed. Results: ①The majority of ACS patients were male (76.5% for men and women: 23.5%, P <0.01). The proportion of female patients gradually increased with age, and there was significant difference between 45-year-old group and 45-year-old group (P <0.05). There was significant difference between the two groups> 55 years old and 55 years old (P <0.01). ② The age <45 years old group and 45 ~ 54 years old group were more related to smoking, family history of coronary heart disease, and the other 3 groups were related to hypertension and diabetes. Serum creatinine was significantly higher in patients aged> 75 years old, and the difference was statistically significant with other groups (P <0.01); serum uric acid also increased, with the difference between 45- 54 years old group and 55-64 years old group Statistical significance (P <0.05, P <0.01). The number of coronary artery lesion increased with age, and the age of <45 years old was mainly single vessel disease, with statistical significance (P <0.01); the age of 65-74 years and> 75 years old group Patients with 3 lesions, with the other three groups were statistically significant differences (P <0.01). ⑤ type of lesion, success rate of revascularization between the groups was no significant difference (P> 0.05). ⑥ medication in different age groups: β-blockers in patients aged <45 years and 55 to 64 years old group and 65 to 74 years old group and> 75 years old group of patients there was a difference (P <0.05); low molecular weight (P <0.05). There was no difference in the use of aspirin, ACEI / ARB and statins (P> 0.05) between the 45- and 54- There was no difference in the incidence of major events or the incidence of recurrent myocardial infarction (P> 0.05), but there was a significant difference in death (P <0.01). Logist multivariate regression analysis found that, except for age, decreased renal function (P <0.01) was an independent risk factor. CONCLUSIONS: The risk factors and coronary artery lesions in patients with ACS in different years have different characteristics. In addition to the comprehensive intervention risk factors, appropriate intervention measures should be taken for the characteristics of coronary lesions in ACS patients of different age groups.