非典型性冠状动脉痉挛患者的临床特点及近期预后  

Clinical features of patients with atypical coronary artery spasm

作　　者：向定成[1] 何建新[1] 洪长江[1] 邱健[1] 马骏[1] 龚志华[1] 张金霞[1] 

机构地区：[1]广州军区广州总医院心内科,510010

出　　处：《中华心血管病杂志》2006年第3期227-230,共4页Chinese Journal of Cardiology

基　　金：广东省自然科学基金资助项目(032186)

摘　　要：目的总结非典型性冠状动脉痉挛患者的临床特点。方法选择临床具有静息性胸痛或胸闷,且冠状动脉造影无显著狭窄的64例患者进行乙酰胆碱冠状动脉痉挛激发试验,将乙酰胆碱试验阳性即冠状动脉痉挛患者根据胸痛或胸闷发作时心电图上是否有ST段抬高分为典型变异型心绞痛组(典型组)和非典型变异型心绞痛性冠状动脉痉挛组(非典型组),比较两组的临床症状特点(危险因素、心电图和核素心肌灌注显像负荷试验结果以及冠状动脉造影和乙酰胆碱试验的影像学)。结果共有46例(72%,46/64)患者诱发冠状动脉痉挛,其中典型组和非典型组分别为12及34例。典型组的平均年龄偏低(P<0·05),血脂代谢紊乱在非典型组更常见,运动心电图试验两组多为阴性,核素灌注心肌显像负荷试验两组均表现有反向再分布,冠状动脉造影典型组多为轻度局限性狭窄或节段性内膜不光滑,肌桥发生率更高,乙酰胆碱试验多诱发节段性痉挛。而非典型组为弥漫性血管细小、内膜不光滑、僵硬,血管迂曲伴远端血流缓慢,乙酰胆碱试验多诱发弥漫性血管痉挛,并可见多支血管同时痉挛。结论非典型性冠状动脉痉挛较典型变异型心绞痛更常见,且具有一定的特征性,应引起临床医生高度重视。Objective This study is aimed to compare the clinical characteristics of patients with typical and atypical coronary artery spasm. Methods Out of 64 patients with chest pain at rest and without significant coronary artery stenosis, coronary artery spasm was provoked by intracoronary injection of acetycholine in 46 patients,including 12 with ST segment elevation （typical coronary artery spasm group） and 34 without ST segment elevation （atypical coronary artery spasm group）. The demographic data, coronary angiographic findings, treadmill electrocardiogram, dipyridamole and rest thallium-201 myocardial perfusion computed tomography, and the follow-up clinical data of the two groups were compared. Results The patients with typical coronary artery spasm were younger （47±6 vs. 58 ± 12,P 〈0. 05） than patients with atypical coronary artery spasm group. Hyperlipidemia were more common in atypical coronary artery spasm group （74% vs. 33% , P 〈0. 05） and myocardial bridging was more common in patients with typical coronary artery spasm group （67% vs. 32%, P 〈 0. 01 ）. Focal coronary spasm during acetycholine provocation was seen in 92% patients with typical coronary spasm and in 32% patients with a atypical coronary artery spasm （ P 〈 0. 01 ） while diffuse coronary spasm was seen in 8% patients with typical coronary spasm and in 6g% patients with a atypical coronary artery spasm （P 〈0.01 ）. All patients with coronary artery spasm were treated with aspirin, calcium channel blockers, long-acting nitroglycerines, with or without lipid-lowering drugs, 2 patients with typical coronary spasm and 4 patients with atypical coronary spasm were rehospitalized due to chest pain and rest of the patients remained free of chest pain during the median follow-up period of 18 ＋ 14 months. Conclusion Atypical coronary artery spasm is common in patients with rest angina and diffuse coronary microvascular spasm might be the cause of chest pain in these patients.

关 键 词：冠状血管痉挛 心绞痛 变异型 乙酰胆碱试验 

分 类 号：R543.3[医药卫生—心血管疾病]