临床诊断急性心肌梗死与冠状动脉造影比较研究  

Comparison and Analysis of Acute Myocardial Infarction with or Without Angiographical Normal Coronary Artery

作　　者：黄浙勇[1] 江时森[1] 汤沂[1] 

机构地区：[1]南京军区总医院/南京大学医学院临床学院心血管内科,江苏南京210002

出　　处：《中国微循环》2005年第3期189-192,共4页Journal of Chinese Microcirculation

摘　　要：目的比较冠状动脉造影(CAG)阴性和CAG阳性的急性心肌梗死(AMI)患者的临床特点。方法对临床诊断急性心肌梗死的399例患者行选择性CAG检查,并据造影结果对临床特点进行对比分析。结果CAG阳性组直径狭窄≥50%者376例,占94.24%,其中狭窄≥90%者307例(81.38%);CAG阴性组直径狭窄<50%者23例,占5.76%,其中0%狭窄7例(30.43%),10%～40%狭窄16例(69.57%)。CAG阴性组与CAG阳性组比较:小于40岁的患者26.08%(6/23)比6.12%(23/376,P<0.05);女性患者43.48%(10/23)比18.88%(71/376,P<0.05);糖尿病、高脂血症、高血压患者分别为26.08%(6/23)比15.69%(59/376),73.91%(17/23)比67.82%(255/376),26.08%(6/23)比28.48%(107/376),P均>0.05;冠心病危险因素数目无显著差异(P>0.05);左室舒张末压(LVEDP)为(12.53±5.46)mmHg比(18.75±7.10)mmHg(P<0.01);左室射血分数(LVEF)为(63.56±8.18)%比(59.56±12.04)%(P>0.05)。结论急性心肌梗死患者中CAG阴性者并非少见,主要发生机制是在冠脉内皮受损基础上冠脉痉挛或冠脉微小斑块破裂促发血栓形成,继而发生血栓自溶或溶栓干预后血栓消失。CAG阴性AMI在年轻人、女性中并不少见,心功能较好,与CAG阳性者具相同的糖尿病、高脂血症、高血压发生率。Objective To compare the clinical characteristics between acute myocardial infarction(AMI)patients with angiographically normal coronary artery and those with angiographically coronary stenosis. Methods 399 consecutive AMI patients underwent selective coronary angiography after hospitalization. The characteristics of CAD risk factors and left ventricular function were compared between the group with angiographically normal coronary artery and the group with angiographically coronary stenosis. Results 94.24%(376/399) cases showed angiographically coronary stenosis: 307 cases of them with coronary stenosis equal to or more than 90%. 5.76%(23/399) cases showed angiographically normal coronary artery: 7 cases with 0% coronary artery diameter stenosis, 16 cases with 10%～40% stenosis. The results compared between the group with normal coronary artery and the group with coronary stenosis were as follows: the percentage of people younger than 40 was 26.08%(6/23) vs 6.12% (23/376)(P<0.05); the percentage of women was 43.48%(10/23) vs 18.88%(71/376)(P<0.05). The percentage of diabetes, hyperlipemia and hypertension was 26.08%(6/23)vs 15.69%(59/376),73.91%(17/23) vs 67.82%(255/376),26.08%(6/23) vs 28.48%(107/376) respectively(P>0.05); There was no statistical difference in terms of the number of risk factor(P>0.05); Left ventricular end diastolic pressure(LVEDP) was 12.53 mmHg±5.46 mmHg vs 18.75 mmHg±7.10 mmHg(P<0.01). Left ventricular ejection fraction(LVEF)was 63.56%±8.18% vs 59.56%±12.04%(P>0.05). Conclusion AMI with angiographically normal coronary artery is not a rare phenomenon, and the mechanism is predominantly related to the dissolution of thrombus, which is usually caused by coronary spasm or rupture of tiny atherosclerotic coronary plagues. Compared with the group with coronary stenosis, the group with angiographically normal coronary artery features a better left ventricular function, more young people and more women, and shares the same proportion of diabetes, hyperlipemia and hypertension.

关 键 词：急性心肌梗死 冠状动脉造影 诊断 

分 类 号：R54[医药卫生—心血管疾病] R814.43[医药卫生—内科学]