冠脉造影正常但有胸痛的高血压患者的临床特点  

Analysis of the clinical characteristics in the chest pain patients with hypertension and non-hypertension without coronary stenosis

作　　者：谢苗荣[1] 陈晖[1] 于俊民 王榭[1] 杨家声[1] 沈潞华[1] 

机构地区：[1]首都医科大学附属北京友谊医院,北京市100050

出　　处：《中国全科医学》2000年第6期440-442,共3页Chinese General Practice

摘　　要：目的　分析冠脉造影正常但有胸痛表现的高血压和非高血压患者的临床特点。方法　将 16 0例冠状动脉造影无明显病变的胸痛患者分为高血压组 (71例 )和非高血压组 (89例 ) ,分析其临床表现、心电图、运动试验、普萘洛尔试验、超声心动图的特点。结果　高血压组多为典型的劳累型心绞痛 (与非高血压组相比P <0 0 1) ,采用以 β受体阻滞剂为主的抗心绞痛治疗常有效 ;静息心电图表现为左室劳损及冠状T波 ,运动试验多阳性 (P <0 0 1) ;左室舒张末期内径、室间隔厚度及左室后壁厚度与非高血压组有明显差异 (P <0 0 5 ) ;冠状动脉迂曲、僵硬。结论　长期高血压而无冠脉狭窄病变的病人可出现典型劳累型心绞痛、冠状T波、运动试验阳性、采用以β受体阻滞剂为主的抗心绞痛治疗有效等表现 ,临床上酷似冠心病 ,冠状动脉造影对这类患者的鉴别有特殊意义。Objective To analyze the clinical characteristics in the chest- pain patients with hypertension and non-hypertension who had no coronary stenosis defined with coronary angiography.Methods There were 160 cases in this study,71 cases in hypertension group and 89 cases in non-hypertension group.All the patients received coronary angiography and rest electrocardiography(ECG),and part of them did exercise test,proranolol ECG test and echocardiography examination because of suspected angina.Results Most of the patients in hypertension group suffered stable angina and had a good response to (-blockers(vs non-hypertension group,P<0 01 and 0 05 respectively=.The rest ECG showed strain left ventricular hypertrophy and coronary T waves,and exercise test produced positive results more easily.There were significantly differences between the two groups in end diastolic dimension(EDD),interventricular septum(IVS) and posterior wall(PW)(vs non-hypertension group P<0 05=.The coronary arteries of hypertension patients were more tortuous and stiff.Conclusion Many patients of hypertension with normal coronary artery may suffer from typical angina and to be diagnosed as coronary heart disease easily.The causes of the chest pain in these patients may be left ventricular hypertrophy or others.(β-blockers is often effective).Coronary angiography is necessary for identifying the hypertension-chest pain from real coronary heart disease.

关 键 词：高血压 冠状动脉造影 胸痛症状 鉴别诊断 

分 类 号：R544.1[医药卫生—心血管疾病] R816.2[医药卫生—内科学]