绝经前后女性冠状动脉病变患者临床及冠状动脉病变特点分析

Characteristics of clinic and coronary lesion in premenopausal and postmenopausal women with coronary disease: a comparative analysis

关键词:  女性  绝经  冠状动脉疾病

Key words:  women  menopause  coronary disease

摘要:

［目的］ 比较分析绝经前后女性冠状动脉（冠脉）病变患者临床及冠脉病变的特点。［方法］ 回顾性分析81例冠脉造影确诊的女性冠脉病变患者，统计绝经前组（14例）和绝经后组（66例）临床及冠脉病变特点，1例绝经前患者诊断血管炎，统计时单独分析。［结果］ 绝经前1例患者血沉加快，冠脉造影示右冠脉弥漫性瘤样扩张临床诊断血管炎。绝经前组冠心病家族史、高脂血症、吸烟的比例明显高于绝经后组（分别为28.6% vs 9.1%，P＜0.05；64.3% vs 22.7%，P＜0.01；14.3% vs 4.5%，P＜0.05）。而高血压、糖尿病的比例低于绝经后组（分别为21.4% vs 81.8%，P＜0.01；21.4% vs 36.5%，P＜0.05)。绝经前组合并非ST段抬高性心肌梗死、多支病变的比例明显低于绝经后组（分别为0 vs 9.1%；22.7% vs 71.4%，P＜0.01)；而复杂病变数低于绝经后组。［结论］ 对于怀疑冠心病的年轻女性患者，必须考虑到非动脉粥样硬化因素导致冠脉疾病的可能；冠心病家族史、吸烟和高脂血症是绝经前女性冠心病发病的重要危险因素；绝经后女性冠心病患者冠脉病变范围增加，病变程度加重。

Abstract:

［Objective］ This study is to identify the clinical characteristics and summarize the features of coronary lesion in premenopausal and postmenopausal women with coronary disease. ［Methods］ Eighty-one women diagnosed as coronary disease confirmed by coronary angiography were enrolled in this retrospective study and were divided into two groups including premenopausal group (n=14) and postmenopausal group (n=66). Clinical characteristics and coronary angiographic findings were compared between the two groups. One premenopausal patient was diagnosed as vasculitis and was analyzed separately. ［Results］ One premenopausal patient was found elevated erythrocyte sedimentation rate and right coronary artery aneurysm and diagnosed as vasculitis. Compared with the postmenopausal patients, the risk factors of smoking, positive family history and hyperlipidemia in the premenopausal patients were more frequently found(28.6% vs 9.1%, P＜0.05; 64.3% vs 22.7%,P＜0.01; 14.3% vs 4.5%,P＜0.05), but the rates of their hypertention and diabetes were lower(21.4% vs 81.8%, P＜0.01; 21.4% vs 36.5%, P＜0.05). The incidence of Non-ST-elevation myocardial infarction and multi-vessel diseases was more frequent in the postmenopausal patients(0 vs 9.1%; 22.7% vs 71.4%, both P＜0.01). ［Conclusion］ For young women with suspected coronary artery disease, it may be associated with other factors besides atherosclerosis. Smoking, positive family history and hyperlipidemia are the major risk factors in premenopausal women with coronary artery disease. Compared with the premenopausal patients, the postmenopausal patients have more chance of coronary vessel problems and more severe coronary artery lesions.