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年輕婦女冠狀動脈疾病心導管特徵及相關危險因子分析

Risk Factors Analysis and Angiographic Features of Coronary Artery Disease in Young Women

摘要


小於50歲的婦女臨床上疑似冠狀動脈疾病,是否每一個人都應積極接受心導管檢查及治療,或是保守性的治療。為尋求更好的判斷,我們將疑似冠狀動脈疾病而接受心導管檢查之婦女共91例,做一回溯性的分析。血管攝影顯示冠狀動脈正常者有43位,另外22位其血管內徑狹窄程度低於50%。剩下的26位,顯示有臨床意義的冠狀動脈狹窄(血管內徑狹窄程度≧50%),其中12位有一條血管病變,11位有二條血管病變,3位有三條血管病變,受侵犯的血管中以左前降枝冠狀動脈最為常見。在有臨床意義狹窄與正常血管兩組的比較中,糖尿病和肥胖是有意義的血管危險因子(P=0.0085和0.04)。經多變異數分析顯示,糖尿病是最主要的獨立血管危險因子,其勝算比為6.88,95%信賴區間為1.2~39.7。危險因子總數少於2個以下者共有42人,其中僅6人(14.3%)是有臨床意義的冠狀動脈疾病,而具有大於等於2個危險因子的受試者共49人,其中20位(40.8%)是有臨床意義的冠狀動脈疾病,兩組間統計上具顯著差異(P=0.005)。另外在胸痛的評估,及休息狀態之心電圖,對冠狀動脈疾病是否有意義狹窄的鑑別,兩者的比較亦是有意義的差別(P=0.00004和0.025)。所以在疑似有冠狀動脈疾病的年輕婦女(小於50歲),若其危險因子小於2個,且無糖尿病,其症狀為非典型的胸悶或胸痛,休息狀態之心電圖呈現正常者,我們可以預測其冠狀動脈的狹窄程度可能是正常或小於50%等無臨床意義的狹窄。

並列摘要


In order to investigate indications for prompt coronary arteriography versus conservative management in women under the age of 50, we analyzed data from 91 women, who were suspected of having coronary disease. Normal coronary arteries were found in 43, and a further 22 had insignificant stenosis (less than 50% narrowing of the luminal diameter). Of the remaining 26 women, 12 had one-vessel, 11 two-vessel, and 3 three-vessel disease. Diabetes and obesity were significantly more frequent in women with significant stenosis than in women with normal arteries. (p=0.0085 and 0.04 respectively) Multivariate analysis confirmed that diabetes was an independent predictor of coronary disease in this series. (odds ratio 6.88, 95% CI 1.2~39.7) Significant coronary disease was present in 40.8% (20 of 49) of women with more than two risk factors but in only 14.3% (6 of 42) of those with less than two risk factors (P=0.005). Women without significant coronary artery disease on arteriography were more likely to have atypical chest pain and a normal resting electrocardiogram. (p=0.00004 and 0.025 respectively) We conclude that diagnostic coronary arteriography is rarely necessary in women younger than 50 who do not have diabetes, who have fewer than two risk factors, whose chest pain is atypical, and who have normal resting electrocardiography.

被引用紀錄


蔡月娥(2009)。冠狀動脈疾患對出院準備服務之成效及其滿意度探討〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834%2fCSMU.2009.00071
徐珮倚(2013)。探討接受冠狀動脈支架置放術前後心絞痛症狀之變化及其相關影響因素〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2013.00156
林毅志(2012)。地區醫院應用平衡計分卡導入心導管中心的模式探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.00992

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