目的 分析不同年龄段男性急性心肌梗死(AMI)患者的危险因素特点及其与冠脉病变程度的相关性.方法 回顾性分析行冠状动脉造影术的1 740例男性AMI患者的临床资料,计算Gensini积分并分为4个等级.分别比较不同年龄组(青年组、中年组及老年组)男性AMI患者4个积分等级的各项危险因素,然后采用有序Logistic回归法分析各年龄组AMI与各项危险因素间的相关程度,并进行排序.结果 不同冠脉病变积分等级之间,青年组男性AMI患者的吸烟、高血脂症、冠心病家族史、SBP、DBP、LVEF、LDL-C、TBil、IBil和Lp(a)均存在明显差异(P均＜0.05);中年组男性AMI患者的吸烟、糖尿病、高血脂症、冠心病家族史、高血压家族史、LVEF、TC、Lp(a)和ApoA均存在明显差异(P均＜0.05);老年组男性AMI患者的高血压、糖尿病、冠心病家族史、FPG、TBil、Lp(a)和ApoA/B均存在明显差异(P均＜0.05).有序Logistic回归分析显示:各年龄组男性AMI患者的独立危险因素,在青年组依次是吸烟(OR=18.973,P=0.012,)、高LDL-C(OR=11.799,P=0.026)、低TBil(OR=3.633,P=0.043)和冠心病家族史(OR=2.662,P=0.008);在中年组依次是糖尿病(OR=9.738,P=0.010)、高TC(OR=3.819,P=0.001)和低LVEF(OR=3.404,P=0.000);在老年组依次是高FPG(OR=2.841,P=0.024)和糖尿病(OR=2.230,P=0.035).结论 不同年龄段男性AMI患者的危险因素各有特点,吸烟、高LDL-C、低TBil和冠心病家族史会严重影响青年男性冠脉病变程度;糖尿病、高TC和低LVEF可加重中年男性的冠脉病变;高FPG及糖尿病是严重威胁老年男性冠脉健康的最主要危险因素.%Objective It is to analyze the characteristics of risk factors and their correlation with coronary artery lesions in male patients with acute myocardial infarction (AMI) at different ages. Methods The clinical data of 1 740 male AMI patients undergoing coronary angiography were retrospectively analyzed. Their Gensini scores were calculated and divided into four grades. The risk factors of four grades of male AMI in different age groups (young group, middle-aged group and elderly group) were compared, and then the correlation between AMI and various risk factors in each age group was analyzed by ordered logistic regression and the results were ordered. Results Between the scores of different coronary lesions, there were differences in smoking, hyperlipidemia, family history of coronary heart disease, SBP, DBP, LVEF, LDL-C, TBil, IBil, and Lp (a) in male AMI patients (P ＜ 0. 05); There were differences in smoking, diabetes, hyperlipidemia, family history of coronary heart disease, family history of hypertension, LVEF, TC, Lp (a) and Apo A in male AMI patients in middle-aged group (P ＜ 0. 05); There were differences in hypertension, diabetes, family history of coronary heart disease, FPG, TBil, Lp (a) and Apo A/Apo B in elderly male AMI patients (P ＜ 0. 05). Ordered logistic regression analysis showed that the independent risk factors for male AMI patients in all age groups were: smoking (OR = 18. 973, P =0. 012), high LDL-C (OR = 11. 799, P = 0. 026), low TBil (OR = 3. 633, P = 0. 043) and family history of coronary heart disease (OR = 2. 662, P = 0. 008) in the youth group; diabetes (OR = 9. 738, P = 0. 010), high TC (OR = 3. 819, P = 0. 001) and low LVEF (OR = 3. 004, P = 0. 000) in the middle-aged group; high FPG (OR = 2. 841, P = 0. 024) and diabetes (OR = 2. 230, P = 0. 035) in the elderly group. Conclusion The risk factors of male AMI patients at different ages have their own characteristics. Smoking, high LDL-C, low TBil and family history of coronary heart disease can seriously influence the degree of coronary artery disease in young men; diabetes high TC and low LVEF can aggravate coronary lesions in middle-aged males; high FPG and diabetes are the most important risk factors for severe coronary heart disease in older men.
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