目的：分析青年女性急性心肌梗死（Acute myocardial infarction, AMI）患者的临床特点，探究相关危险因素与青年女性AMI患者冠状动脉病变严重程度的关系。

方法:收集2013年1月至2016年9月于阜外医院住院并确诊为急性心肌梗死的青年(年龄≤44 岁)女性患者47例为病例组，青年男性患者141例为性别对照组，老年（年龄≥65岁）女性患者141例为年龄对照组。分别将病例组和各对照组进行对比，分析青年女性AMI的临床特征、冠状动脉造影结果。使用Gensini（GS）评分评价冠状动脉造影结果。以GS评分三分位为截点将47例青年女性AMI患者分为三组（低GS评分组,GS评分＜19,n=17；中等GS评分组，19≤GS评分≤36，n=15；高GS评分组，GS评分＞36,n=15），比较三组患者基线资料。以logistic 回归分析法分析高GS评分的危险因素。以受试者工作特征（Receiver operating characteristic, ROC）曲线分析各危险因素预测高GS评分的能力。采用spearman相关方法分析各连续变量同GS评分的相关性。

结果:青年女性组在吸烟比例，身体质量指数（Body mass index, BMI)、血肌酐、血尿酸水平上低于青年男性组，但高密度脂蛋白胆固醇(High density   lipoprotein cholesterol, HDL-C)水平高于青年男性组（p均＜0.05）。而同老年女性组相比，青年女性组合并高血压比例，糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇（Low density lipoprotein cholesterol, LDL-C）水平较低，而HDL-C水平较高（p均＜0.05）。青年女性组较青年男性组GS评分更低（p＜0.05）。同时青年女性AMI组较性别、年龄对照组患者GS评分为0分的比例更高（p均＜0.05）。

在青年女性AMI患者中，高GS评分组较低GS评分组总胆固醇、LDL-C水平更高；高GS评分组超敏C反应蛋白（High sensitivity C-rective protein，hs-  CRP）水平高于中等GS评分组和低GS评分组（p均＜0.05）。多因素logistic回归分析提示hs-CRP为高GS评分的独立危险因素。ROC曲线分析显示，hs-CRP预测高GS评分的曲线下面积(area under curve, AUC)为0.791（95%CI:0.643-0.938）,而当hs-CRP取截点值为2.14mg/L时，其预测高GS评分的灵敏度为：86.7%，特异度为：75.0%。在青年女性AMI患者中BMI（r=0.300, p=0.040）、血尿酸(r=0.293,p=0.047)、hs-CRP（r=0.402, p=0.005）、甘油三酯（r=0.336, p=0.021）、胆固醇（r=0.439, p=0.002）、LDL-C（r=0.393, p=0.006）同GS评分存在显著正相关关系。

结论:青年女性AMI患者较性别对照组和年龄对照组合并动脉粥样硬化危险因素更少且程度更轻；冠状动脉病变严重程度更轻。Hs-CRP是预测青年女性急性心肌梗死冠状动脉病变严重程度的有效指标。

Objective: To analyze the clinical features of young women with acute myocardial infarction (AMI). And to investigate the relations between risk factors and the severity of coronary lesions.

Methods: Clinical and coronary angiographic features were compared respectively between case group(women with AMI, age≤44 years, N=47) and  control groups(men with AMI, age≤44 years, N=141; women with AMI, age≥65 years,N=141). All patients were admitted to Fu Wai Hospital from January 2013 to September 2016. Gensini score (GS score) were used to evaluate coronary angiographic features. These young women with AMI were classified into three groups according to the tertile of the GS score（low GS score, GS score＜19,n=17; intermediate GS score, 19≤GS score≤36, n=15; high GS score, GS score＞36, n=15）, and their clinical features were compared. Logistic regression analysis and receiver operating characteristic（ROC）curve were used to evaluate the efficacy of risk factors in predicting high GS score. And the correlations between continuous variables and GS score  were evaluated by spearman rank analysis.

Results: Prevalence of somking and levels of Body Mass Index (BMI)、serum creatinine、serum uric acid were significantly lower while the level of high density lipoprotein cholesterol （HDL-C） were significantly higher in young women group than in young men group(p＜0.05).  Prevalence of hypertension and levels of glycosylated hemoglobin 、cholesterol、low density lipoprotein cholesterol （LDL-C） were significantly lower while the level of HDL-C were significantly higher in young women group than in elderly women group(p＜0.05). Compared with young men, young women with AMI had a significantly lower GS score( p＜0.05). Meanwhile, compared with control groups, young women with AMI had a higher proportion of patients who had a GS score of 0.

   As for young women with AMI, compared with low GS score group, high GS score group had significantly higher levels of cholesterol and LDL-C(p＜0.05). And the level of hs-CRP was significantly higher in high GS score groups than in intermediate GS score group and low GS score group(p＜0.05). Multivariate logistic regression analysis showed that hs-CRP was an independent risk factor for high GS score in young women with AMI. For hs-CRP, ROC curve analysis showed that the area under curve was 0.791（95%CI: 0.643-0.938）,with an optimal cut-off value of 2.14 mg/L (sensitivity:86.7%, specificity:75%) in predicting high GS score.  Moreover there were positive and significant correlation between BMI（r=0.300, p=0.040）, serum uric acid (r=0.293, p=0.047), hs-CRP（r=0.402, p=0.005）, triglyceride（r=0.336, p=0.021）, cholesterol（r=0.439, p=0.002）, LDL-C（r=0.393, p=0.006）and GS score for young women with AMI.

Conclusion: Young women with AMI have less and milder atherosclerotic risk factors and have less severe coronary lesions than control groups. Hs-CRP is a valuable predictor for the severity of coronary lesions in young women with AMI.