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安徽省部分区域ST段抬高型心肌梗死患者特征和临床表现的性别差异
作者:张文化  马礼坤 
单位:中国科学技术大学第一附属医院/安徽省立医院 心血管内科, 安徽 合肥 230001
关键词:性别 ST段抬高型心肌梗死 医疗质量 流行病学 卫生政策 安徽 
分类号:R542.2
出版年·卷·期(页码):2020·39·第三期(293-298)
摘要:

目的:回顾分析不同年份安徽省ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者特征和临床表现的性别差异。方法:收集安徽省5家医院2001年、2006年和2011年住院STEMI患者的样本,分析住院率、患者特征、临床诊疗和院内结局的性别差异。结果:491例患者中,女性患者比例(30%)显著低于男性(70%)。男女患者的平均年龄分别从2001年的60.5岁和69岁增长至2011年的64岁和73岁(P值分别为0.016、0.458)。年龄校正后,女性患者合并高血压(47.6% vs 38.7%,P=0.057 3)、糖尿病(19.6% vs 10.8%,P=0.007 4)及冠心病(31.5% vs 21.4%,P=0.013 2)的比例高于男性患者;吸烟为男性患者主要致病因素之一(P<0.000 1);女性患者及时就诊率较低;在无禁忌证的患者中,女性患者多接受阿司匹林等药物治疗,男性患者接受再灌注治疗(23.8% vs 39.5%,P=0.025)和氯吡格雷(41.4% vs 54.5%,P=0.008)较高。院内女性患者死亡率远高于男性患者(13.1% vs 5%,P=0.001 4)。不同年份男性患者均多于女性;有效治疗手段再灌注治疗和PCI治疗的接受程度上,男性患者高于女性;女性患者的院内死亡率维持在较高水平。结论:急性STEMI患者具有一定的性别差异。与男性比,女性发病时年龄较大,合并疾病较多,入院时间晚,对进一步治疗的认知及接受度较低,院内死亡率较高。

Objective: To investigate the gender differences in the characteristics, clinical manifestations, and in-hospital outcomes of patients with ST-segment elevation myocardial infarction.Methods: Patients with STEMI admitted to 5 hospitals were selected in the years of 2001, 2006 and 2011, the differences of hospitalization rates, clinical profiles and quality of care were studied. Results: Among 491 patients, the proportion of female patients (30%) was significantly lower than that of men. The average age of male and female patients increased from 60.5 and 69 years in 2001 to 64 and 73 years in 2011(P=0.016, 0.458). After age correction, the proportion of female patients with hypertension (47.6% vs 38.7%, P=0.057 3), diabetes (19.6% vs 10.8%, P=0.007 4) and coronary heart disease (31.5% vs 21.4%, P=0.013 2) was higher than that of male patients; smoking was one of the main pathogenic factors in male patients (P<0.001); female patients had a lower rate of timely visit; among patients without contraindication, female patients received more drugs such as aspirin, while male patients received reperfusion treatment (23.8%, P=0.025%) and clopidogrel (4.1.4%, P=0.008). The mortality rate of hospital female patients was much higher than that of male patients (13.1% vs 5%, P=0.001 4). In different years, male patients were more than female patients. In terms of the acceptance of effective therapy, reperfusion therapy and PCI treatment, more male patients than female patients accepted, and the hospital mortality rate of female patients was maintained at a higher level.Conclusion: Acute STEMI patients have certain gender differences, women have more complications, later admission, lower cognition and acceptance of further treatment, and higher mortality rates in the hospital.

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