冠状动脉微循环障碍在冠状动脉粥样硬化性心脏病中的研究进展
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摘要
冠状动脉粥样硬化性心脏病(CHD)的发病率越来越高,亦呈年轻化趋势,已成为严重影响人类健康的心血管疾病之一。随着医学研究进展,CHD发病机制的研究虽不断深入,但仍不明确。尽管冠状动脉造影(CAG)是诊断CHD的金标准,但大量临床及相关研究表明, CAG正常而仍存在胸痛的患者数量并不罕见,怀疑此现象由冠状动脉微循环障碍(CMD)引起,CMD在CHD发病中具有重要意义。本研究主要通过CMD在CHD中的发病机制、研究进展、评估、治疗及展望作一综述。
The morbidity of coronary atherosclerotic heart disease(CHD) has been in an increasing trend, and also moving more to younger people. It has become one of the cardiovascular diseases seriously affecting human health. With the development of medical research, research into the pathogenesis of CHD has been advanced, but everything is not yet confirmed in this respect. Although coronary arteriongraphy(CAG) is the gold standard for diagnosing CHD, a large number of clinical and related studies have shown that patients with normal CAG and chest pain are not uncommon nowadays. This phenomenon is suspected to be related to coronary microcirculation dysfunction(CMD). It is clear that CMD plays an important role in the pathogenesis of CHD. This article reviewed the pathogenesis, research progress, assessment, treatment and prospects of CMD in CHD.
The morbidity of coronary atherosclerotic heart disease(CHD) has been in an increasing trend, and also moving more to younger people. It has become one of the cardiovascular diseases seriously affecting human health. With the development of medical research, research into the pathogenesis of CHD has been advanced, but everything is not yet confirmed in this respect. Although coronary arteriongraphy(CAG) is the gold standard for diagnosing CHD, a large number of clinical and related studies have shown that patients with normal CAG and chest pain are not uncommon nowadays. This phenomenon is suspected to be related to coronary microcirculation dysfunction(CMD). It is clear that CMD plays an important role in the pathogenesis of CHD. This article reviewed the pathogenesis, research progress, assessment, treatment and prospects of CMD in CHD.
引文
[1]张付娥,王涛,姜志安.冠状动脉微循环障碍的研究进展[J].疑难病杂志, 2016, 15(7):754—757
[2] Chen C, Wei J, Albadri A, et al. Coronary microvascular dysfunction-epidemiology, pathogenesis, prognosis, diagnosis, risk factors and therapy[J]. Circulation Journal Official Journal of the Japanese Circulation Society, 2016,81(1):3—11
[3] Reinstadler SJ, Stiermaier T, Fuernau G, et al. The challenges and impact of microvascular injury in ST-elevation myocardial infarction[J]. Expert Review of Cardiovascular Therapy, 2016, 14(4):431—443
[4] Layland J, Nerlekar N, Palmer S, et al. Invasive assessment of the coronary microcirculation in the catheter laboratory[J]. Internatoinal Journal of Cardiology, 2015, 199:141—149
[5] Mourmoura E, Couturier K, Hininger FI, et al. Functional changes of the coronary microvasculature with aging regarding glucose tolerance, energy metabolism, and oxidative stress[J]. Age(Dordrecht, Netherlands), 2014, 36(4):9670—9678
[6] Titterington JS, Hung OY, Wenger NK. Microvascular angina:an update on diagnosis and treatment[J]. Future Cardiology, 2015, 11(2):229—242
[7]诸葛瑞琪,周荣,倪新海.冠状动脉微血管功能障碍临床诊疗新进展[J].中国循环杂志, 2016, 31(3):307—310
[8] Dean J, Cruz SD, Mehta PK, et al. Coronary microvascular dysfunction:sex-specific risk, diagnosis and therapy[J].Nature Reviews Cardiology, 2015, 12(7):406—414
[9] Michelsen MM, Mygind ND, Pena A, et al. Peripheral reactive hyperemia index and coronary microvascular function in women with no obstructive CAD:The i POWER Study[J]. JACC Cardiovascular Imaging, 2016, 9(4):411—417
[10] Oylumlu M, Oylumla MN, Yuksel M, et al. The usefulness of plateletcrit to predict cardiac syndrome X in patients with normal coronary angiogram[J]. Advances in Interventional Cardiology, 2015, 11(3):197—201
[11]张霄,代玉洁,杨洋,等.冠状动脉微循环障碍及微血管型心绞痛的治疗现状[J].现代生物医学进展, 2016,16(28):5583—5585
[12]张健瑜,梁茜,许兆延.冠状动脉微循环障碍的研究现状及性别差异[J].中国动脉硬化杂志, 2017, 25(8):850—855
[13] Tibirica E, Souza EG, de Lorenzo A, et al. Reduced systemic microvascular density and reactivity in individuals with early onset coronary artery disease[J]. Microvascular Research, 2015, 97(6):105—108
[14] Sanchez ME, Ramirez LI, Gomez DF, et al. Quantitative evaluation of capillaroscopic microvascular changes in patients with established coronary heart disease[J]. Medicina Clínica, 2018, 150(4):131—137
[15] Yagi H, Sumino H, Aoki T, et al. Impaired blood rheology is associated with endothelial dysfunction in patients with coronary risk factors[J]. Clinical Hemorheology&Microcirculation, 2015, 62(2):139—150
[16]王效浣,高奋堂,安彦强,等.测定肱动脉血管内皮功能对绝经后女性冠心病的诊断价值[J].兰州大学学报:医学版, 2014, 40(4):52—56
[17] Ahmadi N, Ruiz GJ, Hajsadeghi F, et al. Impaired coronary artery distensibility is an endothelium-dependent process and is associated with vulnerable plaque composition[J]. Clinical Physiology&Functional Imaging,2016, 36(4):261—268
[18] Al-Fiadh AH, Wong TY, Kawasaki R, et al. Usefulness of retinal microvascular endothelial dysfunction as a predictor of coronary artery disease[J]. American Journal of Cardiology, 2015, 115(5):609—613
[19]王世超,刘玉昊,武越,等.微循环阻力指数对冠状动脉完全闭塞病变择期行介入治疗的预测价值及影响因素[J].中国循环杂志, 2016, 31(4):332—336
[20]张晋东,杨海波,赵荫涛,等.不同类型冠心病患者冠状动脉内斑块特征与炎症因子的相关性[J].中国实用医刊, 2014, 17(2):60—61
[21]贾鹏. TNF-α诱导fg12表达在心脏微循环障碍的作用及机制研究[D].武汉:华中科技大学同济医学院附属协和医院, 2013
[22]卢周舟.冠心病合并阻塞性睡眠呼吸暂停综合症患者的冠脉微循环障碍研究[D].南京:东南大学附属中大医院, 2015
[23] Mekonnen G, Corban MT, Hung OY, et al. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease[J]. Atherosclerosis, 2015, 239(1):55—60
[24]朱蓉,朱惠,贾雪芹,等.活动期与非活动期类风湿关节炎患者血脂变化及心血管风险分析[J].兰州大学学报:医学版, 2015, 41(2):61—67
[25]曾秋棠,彭昱东.急性心肌梗死与冠状动脉微循环障碍[J].临床心血管病杂志, 2017, 8(5):404—406
[26] Sun Dong-dong, Huang Jie, Zhang Zheng, et al. Luteolin limits infarct size and improves cardiac function after myocardium ischemia/reperfusion injury in diabetic rats[J]. PLoS One, 2012, 7(3):e33491
[27] Hollander MR, de Waard GA, Konijnenberg LSF, et al. Dissecting the effects of ischemia and reperfusion on the coronary microcirculation in a rat model of acute myocardial infarction[J]. PLoS One, 2016, 11(7):e0157233—e0157250
[28] Zhou H, Zhang Y, Hu S, et al. Melatonin protects cardiac microvasculature against ischemia/reperfusion injury via suppression of mitochondrial fission-VDAC1-HK2-mPTP-mitophagy axis[J]. Journal of Pineal Research,2017, 63(1):e12413
[29] Hervas A, Dios E, Forteza MJ, et al. Intracoronary infusion of thioflavin-s to study microvascular obstruction in a model of mycardial infarction[J]. Revista Espa?ola De Cardiologia, 2015, 68(11):928—934
[30]何涛,陶天琪,李玉珍,等.不同危险分层原发性高血压病患者甲襞微循环改变[J].微循环学杂志, 2015, 7(3):17—22
[31]马玉龙,李树仁.冠状动脉微循环功能障碍的研究进展[J].中国循环杂志, 2016, 31(6):619—621
[32] Labazi H, Trask AJ. Coronary microvascular disease as an early culprit in the pathophysiology of diabetes and metabolic syndrome[J]. Pharmacological Research, 2017,12(3):114—121
[33]鲁琳,娄明武,申云霞,等.猪冠状动脉微栓塞致心肌梗死模型的建立[J].中国医学影像技术, 2014, 30(11):1605—1608
[34] Peretto G, Lazzeroni D, Sartorio CL, et al. Cardiotoxicity in oncology and coronary microcirculation:future challenges in theranostics[J]. Front Biosci, 2017, 22(3):1760—1773
[35] Shao Liang, Wu Da-ying, Zhang Ping, et al. The significance of microthrombosis and fgl2 in no-reflow phenomenon of rats with acute myocardial ischemia/reperfusion[J]. Clinical&Applied Thrombosis/hemostasis,2012, 19(1):19—28
[36]惠波,夏伟,许文亮,等.冠状动脉分叉处病变重构的血管内超声研究[J].中华超声影像学杂志, 2014, 23(5):450—451
[37] Titterington JS, Hung OY, Wenger NK. Microvascular angina:an update on diagnosis and treatment[J]. Future Cardiology, 2015, 11(2):229—242
[38] Istr?toaie O, Pirici I, Ofi?eru AM, et al. Evaluation of cardiac microvasculature in patients with diffuse myocardial fibrosis[J]. Revue Roumaine De Morphologie et Embryologie, 2016, 57(4):1351—1356
[39] Badimon L, Bugiardini R, Cenko E, et al. Position paper of the European society of cardiology-working group of coronary pathophysiology and microcirculation:obesity and heart disease[J]. European Heart Journal, 2017,38(25):1951—1958.
[40] Sorop O, Olver TD, Van d WJ, et al. The microcirculation:a key player in obesity-associated cardiovascular disease[J]. Cardiovascular Research, 2017, 113(9):1035—1045
[41] Yoshino S, Cilluffo R, Best PJ, et al. Single nucleotide polymorphisms associated with abnormal coronary microvascular function[J]. Coronary Artery Disease, 2014,25(4):281—289
[42] Dean J, Cruz SD, Mehta PK, et al. Coronary microvascular dysfunction:sex-specific risk, diagnosis, and therapy[J]. Nature Reviews Cardiology, 2015, 12(7):406—414
[43]傅向华,肖宇杨,李向明.冠状动脉微循环障碍药物治疗及防治现状[J].内科理论与实践, 2017, 18(1):27—32
[44] Feher A, Sinusas AJ. Quantitative assessment of coronary microvascular function:dynamic single-photon emission computed tomography, positron emission tomography, ultrasound, computed tomography, and magnetic resonance imaging[J]. Circulation Cardiovascular Imaging, 2017, 10(8):e006427
[45]卢健棋,温志浩.中医药干预冠脉微循环障碍的研究近况[J].中国中医基础医学杂志, 2013, 13(5):597—600
[2] Chen C, Wei J, Albadri A, et al. Coronary microvascular dysfunction-epidemiology, pathogenesis, prognosis, diagnosis, risk factors and therapy[J]. Circulation Journal Official Journal of the Japanese Circulation Society, 2016,81(1):3—11
[3] Reinstadler SJ, Stiermaier T, Fuernau G, et al. The challenges and impact of microvascular injury in ST-elevation myocardial infarction[J]. Expert Review of Cardiovascular Therapy, 2016, 14(4):431—443
[4] Layland J, Nerlekar N, Palmer S, et al. Invasive assessment of the coronary microcirculation in the catheter laboratory[J]. Internatoinal Journal of Cardiology, 2015, 199:141—149
[5] Mourmoura E, Couturier K, Hininger FI, et al. Functional changes of the coronary microvasculature with aging regarding glucose tolerance, energy metabolism, and oxidative stress[J]. Age(Dordrecht, Netherlands), 2014, 36(4):9670—9678
[6] Titterington JS, Hung OY, Wenger NK. Microvascular angina:an update on diagnosis and treatment[J]. Future Cardiology, 2015, 11(2):229—242
[7]诸葛瑞琪,周荣,倪新海.冠状动脉微血管功能障碍临床诊疗新进展[J].中国循环杂志, 2016, 31(3):307—310
[8] Dean J, Cruz SD, Mehta PK, et al. Coronary microvascular dysfunction:sex-specific risk, diagnosis and therapy[J].Nature Reviews Cardiology, 2015, 12(7):406—414
[9] Michelsen MM, Mygind ND, Pena A, et al. Peripheral reactive hyperemia index and coronary microvascular function in women with no obstructive CAD:The i POWER Study[J]. JACC Cardiovascular Imaging, 2016, 9(4):411—417
[10] Oylumlu M, Oylumla MN, Yuksel M, et al. The usefulness of plateletcrit to predict cardiac syndrome X in patients with normal coronary angiogram[J]. Advances in Interventional Cardiology, 2015, 11(3):197—201
[11]张霄,代玉洁,杨洋,等.冠状动脉微循环障碍及微血管型心绞痛的治疗现状[J].现代生物医学进展, 2016,16(28):5583—5585
[12]张健瑜,梁茜,许兆延.冠状动脉微循环障碍的研究现状及性别差异[J].中国动脉硬化杂志, 2017, 25(8):850—855
[13] Tibirica E, Souza EG, de Lorenzo A, et al. Reduced systemic microvascular density and reactivity in individuals with early onset coronary artery disease[J]. Microvascular Research, 2015, 97(6):105—108
[14] Sanchez ME, Ramirez LI, Gomez DF, et al. Quantitative evaluation of capillaroscopic microvascular changes in patients with established coronary heart disease[J]. Medicina Clínica, 2018, 150(4):131—137
[15] Yagi H, Sumino H, Aoki T, et al. Impaired blood rheology is associated with endothelial dysfunction in patients with coronary risk factors[J]. Clinical Hemorheology&Microcirculation, 2015, 62(2):139—150
[16]王效浣,高奋堂,安彦强,等.测定肱动脉血管内皮功能对绝经后女性冠心病的诊断价值[J].兰州大学学报:医学版, 2014, 40(4):52—56
[17] Ahmadi N, Ruiz GJ, Hajsadeghi F, et al. Impaired coronary artery distensibility is an endothelium-dependent process and is associated with vulnerable plaque composition[J]. Clinical Physiology&Functional Imaging,2016, 36(4):261—268
[18] Al-Fiadh AH, Wong TY, Kawasaki R, et al. Usefulness of retinal microvascular endothelial dysfunction as a predictor of coronary artery disease[J]. American Journal of Cardiology, 2015, 115(5):609—613
[19]王世超,刘玉昊,武越,等.微循环阻力指数对冠状动脉完全闭塞病变择期行介入治疗的预测价值及影响因素[J].中国循环杂志, 2016, 31(4):332—336
[20]张晋东,杨海波,赵荫涛,等.不同类型冠心病患者冠状动脉内斑块特征与炎症因子的相关性[J].中国实用医刊, 2014, 17(2):60—61
[21]贾鹏. TNF-α诱导fg12表达在心脏微循环障碍的作用及机制研究[D].武汉:华中科技大学同济医学院附属协和医院, 2013
[22]卢周舟.冠心病合并阻塞性睡眠呼吸暂停综合症患者的冠脉微循环障碍研究[D].南京:东南大学附属中大医院, 2015
[23] Mekonnen G, Corban MT, Hung OY, et al. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease[J]. Atherosclerosis, 2015, 239(1):55—60
[24]朱蓉,朱惠,贾雪芹,等.活动期与非活动期类风湿关节炎患者血脂变化及心血管风险分析[J].兰州大学学报:医学版, 2015, 41(2):61—67
[25]曾秋棠,彭昱东.急性心肌梗死与冠状动脉微循环障碍[J].临床心血管病杂志, 2017, 8(5):404—406
[26] Sun Dong-dong, Huang Jie, Zhang Zheng, et al. Luteolin limits infarct size and improves cardiac function after myocardium ischemia/reperfusion injury in diabetic rats[J]. PLoS One, 2012, 7(3):e33491
[27] Hollander MR, de Waard GA, Konijnenberg LSF, et al. Dissecting the effects of ischemia and reperfusion on the coronary microcirculation in a rat model of acute myocardial infarction[J]. PLoS One, 2016, 11(7):e0157233—e0157250
[28] Zhou H, Zhang Y, Hu S, et al. Melatonin protects cardiac microvasculature against ischemia/reperfusion injury via suppression of mitochondrial fission-VDAC1-HK2-mPTP-mitophagy axis[J]. Journal of Pineal Research,2017, 63(1):e12413
[29] Hervas A, Dios E, Forteza MJ, et al. Intracoronary infusion of thioflavin-s to study microvascular obstruction in a model of mycardial infarction[J]. Revista Espa?ola De Cardiologia, 2015, 68(11):928—934
[30]何涛,陶天琪,李玉珍,等.不同危险分层原发性高血压病患者甲襞微循环改变[J].微循环学杂志, 2015, 7(3):17—22
[31]马玉龙,李树仁.冠状动脉微循环功能障碍的研究进展[J].中国循环杂志, 2016, 31(6):619—621
[32] Labazi H, Trask AJ. Coronary microvascular disease as an early culprit in the pathophysiology of diabetes and metabolic syndrome[J]. Pharmacological Research, 2017,12(3):114—121
[33]鲁琳,娄明武,申云霞,等.猪冠状动脉微栓塞致心肌梗死模型的建立[J].中国医学影像技术, 2014, 30(11):1605—1608
[34] Peretto G, Lazzeroni D, Sartorio CL, et al. Cardiotoxicity in oncology and coronary microcirculation:future challenges in theranostics[J]. Front Biosci, 2017, 22(3):1760—1773
[35] Shao Liang, Wu Da-ying, Zhang Ping, et al. The significance of microthrombosis and fgl2 in no-reflow phenomenon of rats with acute myocardial ischemia/reperfusion[J]. Clinical&Applied Thrombosis/hemostasis,2012, 19(1):19—28
[36]惠波,夏伟,许文亮,等.冠状动脉分叉处病变重构的血管内超声研究[J].中华超声影像学杂志, 2014, 23(5):450—451
[37] Titterington JS, Hung OY, Wenger NK. Microvascular angina:an update on diagnosis and treatment[J]. Future Cardiology, 2015, 11(2):229—242
[38] Istr?toaie O, Pirici I, Ofi?eru AM, et al. Evaluation of cardiac microvasculature in patients with diffuse myocardial fibrosis[J]. Revue Roumaine De Morphologie et Embryologie, 2016, 57(4):1351—1356
[39] Badimon L, Bugiardini R, Cenko E, et al. Position paper of the European society of cardiology-working group of coronary pathophysiology and microcirculation:obesity and heart disease[J]. European Heart Journal, 2017,38(25):1951—1958.
[40] Sorop O, Olver TD, Van d WJ, et al. The microcirculation:a key player in obesity-associated cardiovascular disease[J]. Cardiovascular Research, 2017, 113(9):1035—1045
[41] Yoshino S, Cilluffo R, Best PJ, et al. Single nucleotide polymorphisms associated with abnormal coronary microvascular function[J]. Coronary Artery Disease, 2014,25(4):281—289
[42] Dean J, Cruz SD, Mehta PK, et al. Coronary microvascular dysfunction:sex-specific risk, diagnosis, and therapy[J]. Nature Reviews Cardiology, 2015, 12(7):406—414
[43]傅向华,肖宇杨,李向明.冠状动脉微循环障碍药物治疗及防治现状[J].内科理论与实践, 2017, 18(1):27—32
[44] Feher A, Sinusas AJ. Quantitative assessment of coronary microvascular function:dynamic single-photon emission computed tomography, positron emission tomography, ultrasound, computed tomography, and magnetic resonance imaging[J]. Circulation Cardiovascular Imaging, 2017, 10(8):e006427
[45]卢健棋,温志浩.中医药干预冠脉微循环障碍的研究近况[J].中国中医基础医学杂志, 2013, 13(5):597—600