作者：路翔宇，滕天琦，夏勇

单位：

221000 江苏省徐州市，徐州医科大学附属医院心内科；通信作者：夏勇，E-mail：xiayongphd@163.com

关键词：

心肌梗死；经皮冠状动脉介入治疗；青年人；临床特征；预后

Keywords：

Myocardial infarction；Percutaneous coronary intervention；Young adult；Clinical characteristics；Prognosis

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.019

Funds：

摘要：

目的　分析行急诊经皮冠状动脉介入治疗（PCI）的青年急性 ST 段抬高型心肌梗死（STEMI）患者的临床特征及住院期间预后。方法　回顾性选取 2017 年 11 月—2019 年 5 月在徐州医科大学附属医院心内科住院并诊断为 STEMI 且接受急诊 PCI 患者 482 例，根据年龄分为老年组（≥ 45 岁，n=325）和青年组（<45 岁，n=157）。比较两组患者一般资料、实验室检查指标、冠状动脉病变特征、PCI 路径、穿刺并发症、梗死血管、支架个数、支架长度、住院期间预后及住院时间。结果　青年组患者高血压、糖尿病、脑梗死者所占比例低于老年组，男性所占比例、体质指数（BMI）、有吸烟史者所占比例、有冠心病家族史者所占比例高于老年组（P<0.05）。青年组患者总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、尿酸、白细胞计数（WBC）高于老年组，高密度脂蛋白胆固醇（HDL-C）、脂蛋白、D- 二聚体、超敏肌钙蛋白 T（hs-TNT）、N 末端脑钠肽前体（NT-proBNP）峰值低于老年组（P<0.05）；两组患者肌酐、血糖、纤维蛋白原（FIB）比较，差异无统计学意义（P>0.05）。青年组患者 3 支病变及梗死相关动脉 B1 型、B2型、C 型者所占比例低于老年组，1 支病变及梗死相关动脉病变 A 型者所占比例高于老年组（P<0.05）。两组患者梗死血管比较，差异无统计学意义（P>0.05）；青年组患者PCI入路为桡动脉者所占比例高于老年组，穿刺并发症发生率、支架个数低于老年组，支架长度短于老年组（P<0.05）。青年组患者心律失常发生率、心力衰竭发生率、病死率低于老年组，住院时间短于老年组（P<0.05）。结论　青年 STEMI 患者与男性、肥胖、吸烟、冠心病家族史、血脂异常、高 WBC、高尿酸有关，且与老年患者比较，青年患者多经桡动脉行 PCI，穿刺并发症及植入支架少，支架长度短，多为单支病变，梗死血管多为左前降支（LAD），梗死相关动脉病变分型多为 A 型、B1 型，住院期间预后较好且住院时间短。

Abstract：

Objective　To analyze the clinical characteristics and prognosis of hospitalization in acute ST-segmentelevation myocardial infarction （STEMI） young patients treated by emergency percutaneous coronary intervention （PCI）.Methods　482 cases with STEMI and receiving emergency PCI in Department of Cardiology，the Affiliated Hospital of XuzhouMedical University from November 2017 to May 2019 were analyzed retrospectively.They were divided into elderly group （≥ 45years old，n=325）and youth group （<45 years old，n=157）according to ages.General information，laboratory examinationindexes，coronary artery lesions，PCI pathways，puncture complications，infarcted arteries，number of stents implanted，length of stents implanted，prognosis during hospitalization and length of hospitalization were compared between the two groups.Results　Proportion of hypertension，diabetes and cerebral infarction in youth group were statistically significantly lower thanthose in elderly group，while proportion of male，BMI，smoking history and family history of coronary heart disease werestatistically significantly higher than those in elderly group（P<0.05）.TC，LDL-C，uric acid and WBC in youth group werestatistically significantly higher than those in elderly group，while HDL-C，lipoprotein，D-Dimer，hs-TNT and NT-proBNPwere statistically significantly lower than those in elderly group（P<0.05）.There was no statistically significant differencein Cr，blood glucose and FIB between the two groups（P>0.05）. Proportion of number of arterial lesions 3 and infarct-related artery classification of B1，B2，C in youth group were statistically significantly lower than those in elderly group，while proportion of number of arterial lesions 1 and infarct-related artery classification of A were statistically significantly higherthan those in elderly group（P<0.05）.There was no statistically significant difference in infarct-related artery between thetwo groups（P>0.05）.Proportion of radial artery used as the PCI pathway in youth group was statistically significantle higherthan that in elderly group，incidence of puncture complications and number of implanted stents were statistically significantlylower than those in elderly group，and the length of the stent implantation was statisticallysignificantly shorter than that inelderly group（P<0.05）. Incidence of arrhythmia，heart failure and mortality in youth group were statistically statisticallylower than those in elderly group，while length of hospitalization was statistically significantly shorter than that in elderly group（P<0.05）.Conclusion　Young patients with STEMI are associated with male，obesity，smoking，family history of coronaryheart disease，dyslipidemia，high WBC，high uric acid.Compared with elderly patients with STEMT，young patients mostlyunderwent PCI with the radial artery，and complications of puncture and stent implantation are fewer and the length of the stentimplantation is short，single-vessel lesions，infarct-related arteries are mostly LAD，infarct-related artery classifications aremostly A and B1 lesions，and young patients have better prognosis and shorter hospitalization time.

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