冠状动脉非阻塞性心肌梗死的病因及临床特征分析  

Etiology and clinical features of myocardial infarction with nonobstructive coronary arteries

作　　者：杨明栋[1] Yang Mingdong(Department of Cardiology,Nanyang Oilfield General Hospital,Nanyang 473132,China)

机构地区：[1]河南省南阳油田总医院心内科,473132

出　　处：《中国实用医刊》2021年第10期17-21,共5页Chinese Journal of Practical Medicine

摘　　要：目的:分析冠状动脉非阻塞性心肌梗死的病因及临床特征。方法:回顾性分析2014年1月至2020年2月于南阳油田总医院诊断为急性心肌梗死且接受冠状动脉造影检查的1050例患者。根据冠状动脉造影检查结果分为冠状动脉阻塞性心肌梗死组(MI-CAD组,970例)和冠状动脉非阻塞性心肌梗死组(MINOCA组,80例)。分析MINOCA病因和症状体征,比较两组患者的基本资料、实验室检查结果、药物治疗情况、住院期间主要不良心血管事件。结果:80例MINOCA患者主要病因为:冠状动脉斑块破裂21例(26.25%),冠状动脉痉挛13例(16.25%),冠状动脉血栓及栓塞11例(13.75%),冠状动脉夹层7例(8.75%),2型急性心肌梗死7例(8.75%),Takotsubo心肌病5例(6.25%),未识别心肌炎3例(3.75%),另外13例未发现明确病因。而临床症状主要表现为胸闷、胸痛,持续时间超过1 h,部分患者有心悸、气急、乏力、晕厥、低热等症状。MINOCA组与MI-CAD组性别、年龄、冠心病史比较,差异有统计学意义(P<0.05)。与MI-CAD组比较,MINOCA组患者低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、空腹血糖(FPG)、肌钙蛋白I(cTn I)、肌酸激酶同工酶(CK-MB)水平均较低(P<0.05);超声心动图结果:与MI-CAD组比较,MINOCA组患者的左室射血分数较高(P<0.05);心电图结果:与MI-CAD组比较,MINOCA组正常、T波改变的发生率均较低(P<0.05);ST段抬高、完全性左束支传导、病理性Q波形成的发生率均较高(P<0.05);住院期间,与MI-CAD组比较,MINOCA组患者使用ACEI/ARB、β受体阻滞剂、他汀类药物的比例较低(P<0.05);与MI-CAD组比较,MINOCA组患者心力衰竭发生率更低(P<0.05)。结论:与MI-CAD患者比较,MINOCA患者的病因及临床特征无明显特异性,临床应重视MINOCA,明确病因,尽早确诊,制定合理的个性化治疗方案,更好地指导MINOCA诊治,改善患者预后。Objective To analyze the etiology and clinical features of myocardial infarction with nonobstructive coronary arteries.Methods A total of 1050 patients with acute myocardial infarction diagnosed by coronary angiography in Nanyang Oilfield General Hospital from January 2014 to February 2020 were retrospectively analyzed.According to the results of coronary angiography,they were divided into myocardialinfarction associated with obstructive coronary artery disease group(MI-CAD group,970 cases)and myocardial infarction with nonobstructive coronary arteriesgroup(MINOCA group,80 cases).The causes and clinical symptoms of MINOCA were analyzed.The basic data,laboratory test results,drug treatment,and major adverse cardiovascular events during hospitalization were compared between the two groups.Results The main causes of 80 minoca patients were as follows:21 cases of coronary plaque rupture(26.25%),13 cases of coronary artery spasm(16.25%),11 cases of coronary artery thrombosis and embolism(13.75%),7 cases of coronary artery dissection(8.75%),7 cases of type 2 acute myocardial infarction(8.75%),5 cases of Takotsubo cardiomyopathy(6.25%),3 cases of unrecognized myocarditis(3.75%),and 13 cases of no clear cause.The clinical symptoms mainly included chest tightness and chest pain,lasting more than 1 hour,and some patients have symptoms such as palpitations,shortness of breath,fatigue,syncope,and low-grade fever.There were significant differences in gender,age and history of coronary heart disease between MI-CAD group and MINOCA group(P<0.05).Compared with the MI-CAD group,the low density lipoprotein cholesterol(LDL-C),triglyceride(TG),fasting blood glucose(FPG),troponin I(cTn I),creatine kinase isoenzyme(CK-MB)levels of the MINOCA group were lower(P<0.05).Echocardiographic results:compared with the MI-CAD group,the left ventricular ejection fraction of the MINOCA group was higher(P<0.05);electrocardiogram results:compared with the MI-CAD group,the incidence of normal and T wave changes in the MINOCA group were lower(P<0.05)

关 键 词：冠状动脉 心肌梗死 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病]