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	非ST段抬高急性冠状动脉综合征女性患者二年随访
其他题名	Two-Year Follow-up of Female Patients with Acute Ischemic Syndrome without ST Elevation
	张竞涛; 谭慧琼; 朱俊; 李建东; 梁岩; 章晏; 刘力生
来源期刊	中国循证医学杂志
ISSN	1672-2531
出版年	2010
卷号	10 期号:8 页码:887-891
中文摘要	目的研究非ST段抬高急性冠状动脉综合征(NSTE-ACS)女性患者的临床特点、治疗现状及2年自然病程.方法本研究为国际性急性冠状动脉综合征登记试验(OASIS)的一部分.按统一方案登记因NSTE-ACS入院的患者,对入选患者的治疗不作任何干预,记录其临床特征、主要药物及干预治疗、重大事件,进行前瞻性、多中心的追踪记录2年,分析女性患者的特点并与男性患者对比进行单因素分析.结果中国大陆地区共注册 2294例NSTE-ACS患者,女性占37.7%(864例),平均年龄65.16.7岁,就诊时有不稳定心绞痛及心电图异常者分别占90.7%、92.6%.女性患者既往有高血压、糖尿病史者分别占64.1%、23.4%,显著高于男性(P≤0.001).女性患者既往有冠心病、陈旧心肌梗死、吸烟、接受经皮冠状动脉介入(PCI)者分别占39.4%、16.8%、11.7%、2.3%,均明显低于男性(P≤0.001),既往接受冠状动脉旁路移植术(CABG)者占0.5%,低于男性(P≤0.05).住院期间女性患者抗血小板制剂、p-受体阻滞剂治疗率分别为92.8%、64.8%,低于男性(p≤0.05);硝酸酯类药、转换酶抑制剂、钙拮抗剂和调血脂治疗率分别为96.9%、60.0%、59.1%、47.1%,与男性相比差异无统计学意义.出院后女性患者药物治疗率下降幅度比男性更为明显.随访2年时女性患者抗血小板制剂、beta一受体阻滞剂、转换酶抑制剂、调血脂药的服用率分别为68.4%、39.5%、27.4%和19.4%,均显著低于男性(P≤0.05).住院期间女性患者PCI、CABG治疗率分别为10.5%和2.7%;2年随访期间分别为13.4%和4.8%.女性血运重建治疗无论是在住院期间或2年随访期间均显著低于男性(P≤0.001).2年随访期间女性患者死亡、再发心肌梗死、卒中、心力衰竭、因顽固心肌缺血住院率分别为7.4%、4.7%、6.8%、15.4%和31.3%,与男性相比差异均无统计学意义(P值均>0.05).结论NSTE-ACS女性患者接受治疗和/或重视治疗的程度明显低于男性.在目前治疗不及男性的情况下女性的重大事件发生率与男性组相比无统计学差异,女性性别是NSTE-ACS重要事件的保护因素
英文摘要	Objective To research clinic characteristics, therapies and 2-year progress offemale patients with Non-ST-segment Elevation Acute Coronary Syndrome (NSTE-ACS). Methods This study was part of the internationalized Organization to Assess Strategies for Ischemic Syndromes (OASIS)registry. There was no intervention in the therapy. Patients admitted to hospital with NSTE-ACS (including unstable angina and non-Q wave myocardialinfarction)were enrolled. The patients’ clinical characteristics, treatment procedure, major events in hospital and two-year progress were recorded by filling in Case Report Forms. Single-variate analyses were made between patients of difference genders. Results A total of 2 294 patients with NSTE-ACS were enrolled in China. The female patients were 37.7% (n=864), whose mean age was 65.16.7 years. Unstable angina dominant (90.7%)was noted on admission. The percentage of patients with abnormal ECG was 92.6%.The prior hypertension and diabetes were 64.1% and 23.4%, respectively,in female patients which were evidently higher than those of males (P≤0.001).The prior coronary heart disease, old myocardial infarction, smoking, and percutaneous coronary intervention (PCI)were 39.4%,16.8%,11.7%, and 2.3% respectively,in females, which were evidently lower than in males (P≤0.001).The prior history of coronary artery bypass graft (CABG)surgery was 0.5% in females, which was evidently lower than in males(P≤0.05): During hospitalization, the therapeutic rates of anti-platelets and3-adrenergic blockers were 92.8% and 64.8%, respectively,in female patients, which were observably lower than in males (P≤0.05).The therapeutic rates of nitrates, angiotensin-converting enzyme inhibitor (ACEI), calaum antagonists, lipid lowering agents were 96.9%,60.0%,59.1%, and 47.1%, respectively,in females, which were not significantly different from those of males. The medication rate in females fell off gradually after discharge, which was more evident than in males. In two-year follow up, the therapeutic rates of anti-platelets,p-adrenergic blockers,ACEI, and lipid lowering agents were 68.4%,39.5%,27.4%, and 19.4%, respectively,in female patients, which were markedly lower than those in males (p≤0.05). During hospitalization, the therapeutic rates of PCI and CABG were 10.5% and 2.7%, respectively. In two year follow-up, their therapeutic rates were 13.4% and 4.8%, respectively. The rate of females performing revascularization procedures was evidently lower than that of males (P≤0.001), either during hospitalization or in twoyear follow up. In two years of follow up, mortality and incidence rates of new myocardial infarction, stroke, heart failure, hospitalization because of refractory angina were 7.4%,4.7%,6.8%,15.4%, and 31.3%, respectively,in female patients. There were no significant differences between females and males (P>0.05). Conclusion Compared with male patients, female patients with NSTE-ACS are less likely to adopt and/or attach importance to treatment. As to the reason why there are no significant differences in major events of NSTE-ACS between females and males under the current circumstance that females’ treatment is inferior to males’, gender of females is an important protective factor
中文关键词	女性 ; 不稳定心绞痛 ; 非Q波心肌梗死 ; 预后
英文关键词	Female Unstable angina Non Q-wave myocardialinfarction Prognosis
语种	中文
国家	中国
收录类别	CSCD
WOS类目	MEDICINE GENERAL INTERNAL
WOS研究方向	General & Internal Medicine
CSCD记录号	CSCD:3980869
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/226072
作者单位	中国医学科学院北京协和医学院心血管病研究所,阜外心血管病医院心内科急重症中心, 北京 100037, 中国
推荐引用方式 GB/T 7714	张竞涛,谭慧琼,朱俊,等. 非ST段抬高急性冠状动脉综合征女性患者二年随访[J],2010,10(8):887-891.
APA	张竞涛.,谭慧琼.,朱俊.,李建东.,梁岩.,...&刘力生.(2010).非ST段抬高急性冠状动脉综合征女性患者二年随访.中国循证医学杂志,10(8),887-891.
MLA	张竞涛,et al."非ST段抬高急性冠状动脉综合征女性患者二年随访".中国循证医学杂志 10.8(2010):887-891.