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目的:了解我国二级医院急性ST段抬高型心肌梗死(STEMI)患者住院死亡率的性别差异及其影响因素。方法:2011-09到2014-06期间在全国15个省或自治区99家二级医院收录共计5 525例因STEMI住院的患者,其中男性3 876例,女性1 649例。比较住院死亡率的性别差异,使用多因素Logistic回归分析差异的相关因素。结果:所有研究对象中,女性占29.8%,男性占70.2%。住院死亡率在女性与男性中分别为13.2%和5.9%,P<0.01。该性别差异无论年龄高低、是否既往有心肌梗死、高血压、糖尿病均显著存在,在不具备任何疾病史和心血管危险因素的患者中,女性死亡率仍大于男性。与男性相比,女性患病时的平均年龄偏大,且更易合并心血管危险因素,入院后10 min内心电图检查、药物治疗及溶栓比例低于男性,但经过多因素分析调整混杂因素后女性死亡率仍显著大于男性[比值比(OR):1.7,95%可信区间(CI):1.4~2.0]。结论:我国二级医院STEMI患者住院死亡率在女性患者中显著高于男性患者。和男性相比,女性患者具备以下特点:发病平均年龄较大,合并心血管风险因素更多,且入院后10 min内心电图检查、药物治疗以及溶栓治疗力度不足。
Objective: To understand the gender differences in in-hospital mortality in acute ST-segment elevation myocardial infarction (STEMI) patients in secondary hospitals and its influencing factors. Methods: A total of 5 525 hospitalized patients with STEMI were enrolled in 99 second-level hospitals in 15 provinces or autonomous regions from September 2011 to June 2014. There were 3 876 males and 1 649 females. Gender differences in in-hospital mortality were compared and multivariate Logistic regression was used to analyze the correlation of differences. Results: Of all the subjects, 29.8% were women and 70.2% were men. In-hospital mortality was 13.2% and 5.9% in women and men, respectively, P <0.01. Regardless of age, this gender difference is significant in the presence of MI, hypertension, and diabetes, and in women who do not have any history of disease and cardiovascular risk factors, the female mortality rate is still greater than that of men. Compared with males, the average age at onset of females was large and more likely to be associated with cardiovascular risk factors. The electrocardiogram (ECG) test, drug treatment and thrombolysis rate were lower in 10 min after admission than those in males, but after adjusting for confounding factors by multivariate analysis Female mortality was still significantly greater than men [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.4-2.0]. Conclusion: The in-hospital mortality rate of STEMI patients in secondary hospitals in our country is significantly higher than that of male patients. Compared with males, females have the following characteristics: the average age of onset is higher, more cardiovascular risk factors are combined, and electrocardiogram, drug therapy and thrombolytic therapy are not enough within 10 minutes after admission.