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男性和女性急性心肌梗死患者住院死亡率差异的原因探讨

蒋世亮,张运,季晓平,王晓荣,宋兆峰   

  1. 山东大学齐鲁医院心内科,山东 济南 250012
  • 收稿日期:2005-10-29 修回日期:1900-01-01 出版日期:2006-08-24 发布日期:2006-08-24
  • 通讯作者: 蒋世亮

Cause of the difference on inhospital mortality between male and female patients with acute myocardial infarction

JIANG Shi-liang,JI Xiao-ping,WANG Xiao-rong,SONG Zhao-feng, ZHANG Yun   

  1. Shandong University, Jinan 250012, Shandong, China
  • Received:2005-10-29 Revised:1900-01-01 Online:2006-08-24 Published:2006-08-24
  • Contact: JIANG Shi-liang

摘要: 目的:通过比较男性和女性急性心肌梗死(AMI)患者的临床特征及住院治疗,探讨不同性别住院死亡率差异的原因。方法:回顾性研究1994年1月至2004年12月在我院住院的1246例男性和537例女性AMI患者,对比不同性别患者的临床特征、住院治疗和预后的差异。结果:与男性相比,女性患者年龄大[(67.7±8.5)岁vs (60.4±11.6)岁, P<0.001],高血压和糖尿病患病率高(51.40% vs 39.25%,28.31% vs 14.69%,P均<0.001),入院时血清总胆固醇>4.68?mmol/L和心功能≥killipⅢ级者多(73.37% vs 57.22%,11.92% vs 5.22%,P均<0.001)。男性和女性的心绞痛史(64.53% vs 66.85%,P=0.344)、陈旧性心肌梗死史(8.91% vs 9.87%,P=0.519)和冠心病家族史(22.98% vs 20.68%,P=0.348)阳性率无显著性差异。男性患者多有吸烟和饮酒史(69.74% vs 14.71%,78.49% vs 24.77%,P均<0.001)。女性患者急性期再灌注治疗率(22.16% vs 28.01%,P=0.010)和住院期间β受体阻滞剂的使用率显著低于男性(64.43% vs 70.14%,P=0.017)。女性患者住院死亡率高于男性(11.92% vs 6.90%,P<0.001)。结论:女性AMI患者住院死亡率显著高于男性,造成这一差异的原因在于不同性别患者的临床特征和住院治疗不同,女性患者年龄大,伴随危险因素多,急性期再灌注治疗率和β受体阻滞剂的使用率亦显著低于男性。

Abstract: December 2004. Variables including baseline characteristics, inhospital management and outcomes were recorded and compared between different gender groups. Results: Females were generally older than males (67.7±8.5 vs 60.4±11.6 years, P<0.001) and had a higher prevalence of hypertension(51.40% vs 39.25%, P<0.001)and diabetes mellitus(28.31% vs 14.69%, P<0.001).The Killip class greater than or equal to Ⅲ(11.92% vs 5.22%,P<0.001) and the total cholesterol (TC)>4.68?mmol/L(73.37% vs 57.22%,P<0.001)were more common in females. There was no significant difference on the history of previous angina pectoris, myocardial infarction and family coronary heart disease between males and females (64.53% vs 66.85%,P=0.344;8.91% vs 9.87%,P=0.519;22.98% vs 20.68%,P=0.348, respectively), however, the history of cigarette smoking(69.74% vs 14.71%, P<0.001) and alcohol drinking(78.49% vs 24.77%,P<0.001) was more common in males. Reperfusion therapy within the first 24 hours after symptom onset and β-blockers were underused during hospitalization phase in females compared with males (22.16% vs 28.01%, P=0.010; 64.43% vs 70.14%, P=0.017, respectively). An increased mortality was demonstrated in females during the hospitalization phase of AMI(11.92% vs 6.90%, P<0.001). Conclusions: The inhospital mortality of females is higher than that of males following AMI. Females are older and have more risk factors than males, and reperfusion therapy and βblockers are underused, all of which are important causes of the difference on inhospital mortality between male and female patients with AMI.

Key words: Acute myocardial infarction, Sex factors, Mortality

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