平板运动试验阳性或可疑阳性而冠状动脉造影正常临床分析
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摘要
目的：对29例平板运动试验阳性或可疑阳性而冠状动脉造影正常的胸痛待诊病人的临床特征进行回顾性分析，为胸痛的临床诊断提供思路。
方法：用回顾性病历分析方法，选择29例平板运动试验阳性或可疑阳性、冠状动脉造影结果正常的胸痛待诊病人，对其临床症状及辅助检查结果进行分析。
结果：29例平板运动试验阳性或可疑阳性而冠状动脉造影结果正常的胸痛待诊病人中，男14例，女15例，年龄37~65（49.82 ±3.56）岁。临床特征：①不典型心绞痛症状患者16例（55.17％），典型心绞痛症状患者13例（44.8％）；②存在高血压者4例（13.79％）；③心律失常6例（20.69%）；④糖耐量异常3例（10.34%）；⑤血脂异常者16例（55.17％）其中甘油三酯增高居多14例（48.27％）；⑥未发现心血管危险因素者9例（31.03％）；辅助检查结果改变：平板运动试验阳性22例，可疑阳性7例；静息心电图ST-T段改变20例，正常9例；同位素心肌灌注显像心肌缺血1例；超声心动图正常22例；X线胸片检查正常29例。
结论：①以不典型心绞痛为主要症状，不伴或极少冠心病危险因素，平板运动试验阳性或可疑阳性的患者，临床诊断为冠心病应慎重，最好通过冠状动脉造影检查明确诊断。②以典型心绞痛为主要症状，平板运动试验阳性或可疑阳性而冠状动脉造影正常的患者，其发病机制尚未完全阐明，考虑与冠状微血管异常及冠脉重构有关。
Objective:To analyze the clinical features of patients with chest pain and abnormal treadmill exercise test but normal coronary angiography.
Methods:The clinical datas of 29 patients with chest pain and abnormal treadmill exercise test but normal coronary angiography were analyzed retrospectively.
Results:In 29 cases patients with chest pain and abnormal treadmill exercise test but normal coronary angiography:the total group including 14 males and15 females,age ranged from 37 to 65(49.82 ±3.56) years;①most of patients had atypical chest Pain in16 cases(55.17％),patients had typical chest Pain in 13 cases(44.13％);②hypertension existed in 4 cases (13.79%);③cardiac arrhythmia existed in 6 cases(20.7%);④IGT existed in 3 cases(10.34%);⑤case of high plasma TC level(14 cases, 48.27％) were predominant in abnormal plasma lipid level(16 cases,55.17%).⑥there were 9 cases(31.03%) without risky factor.⑦results of treadmill exercise test were positive in 22 patients and doubtful positive in 7 patients;there were 20 cases whose ST-T of rest status ECG changed and 9 cases whose rest status ECG was normal;there was 1 case demonstrated myocardial ischemic by myocardial perfusion imaging; echocardiography were normal in 22 cases;X-ray test were normal in 29 cases.
Conclusion:To these who have seldomly cardiac vascular risk factors and have untypical symptom of angina pectoris,the diagnosis of CHD should be maden cautiously even though they have abnormal treadmill exercise test.It is suggested that coronary angiography should be considered for these pectoris.
To these who have typical symptom of angina pectoris and abnormal treadmill exercise test but normal coronary angiography,the mechanisms of the disease was unclear.Microvascular angina and coronary arteries remodeling are relational.
方法：用回顾性病历分析方法，选择29例平板运动试验阳性或可疑阳性、冠状动脉造影结果正常的胸痛待诊病人，对其临床症状及辅助检查结果进行分析。
结果：29例平板运动试验阳性或可疑阳性而冠状动脉造影结果正常的胸痛待诊病人中，男14例，女15例，年龄37~65（49.82 ±3.56）岁。临床特征：①不典型心绞痛症状患者16例（55.17％），典型心绞痛症状患者13例（44.8％）；②存在高血压者4例（13.79％）；③心律失常6例（20.69%）；④糖耐量异常3例（10.34%）；⑤血脂异常者16例（55.17％）其中甘油三酯增高居多14例（48.27％）；⑥未发现心血管危险因素者9例（31.03％）；辅助检查结果改变：平板运动试验阳性22例，可疑阳性7例；静息心电图ST-T段改变20例，正常9例；同位素心肌灌注显像心肌缺血1例；超声心动图正常22例；X线胸片检查正常29例。
结论：①以不典型心绞痛为主要症状，不伴或极少冠心病危险因素，平板运动试验阳性或可疑阳性的患者，临床诊断为冠心病应慎重，最好通过冠状动脉造影检查明确诊断。②以典型心绞痛为主要症状，平板运动试验阳性或可疑阳性而冠状动脉造影正常的患者，其发病机制尚未完全阐明，考虑与冠状微血管异常及冠脉重构有关。
Objective:To analyze the clinical features of patients with chest pain and abnormal treadmill exercise test but normal coronary angiography.
Methods:The clinical datas of 29 patients with chest pain and abnormal treadmill exercise test but normal coronary angiography were analyzed retrospectively.
Results:In 29 cases patients with chest pain and abnormal treadmill exercise test but normal coronary angiography:the total group including 14 males and15 females,age ranged from 37 to 65(49.82 ±3.56) years;①most of patients had atypical chest Pain in16 cases(55.17％),patients had typical chest Pain in 13 cases(44.13％);②hypertension existed in 4 cases (13.79%);③cardiac arrhythmia existed in 6 cases(20.7%);④IGT existed in 3 cases(10.34%);⑤case of high plasma TC level(14 cases, 48.27％) were predominant in abnormal plasma lipid level(16 cases,55.17%).⑥there were 9 cases(31.03%) without risky factor.⑦results of treadmill exercise test were positive in 22 patients and doubtful positive in 7 patients;there were 20 cases whose ST-T of rest status ECG changed and 9 cases whose rest status ECG was normal;there was 1 case demonstrated myocardial ischemic by myocardial perfusion imaging; echocardiography were normal in 22 cases;X-ray test were normal in 29 cases.
Conclusion:To these who have seldomly cardiac vascular risk factors and have untypical symptom of angina pectoris,the diagnosis of CHD should be maden cautiously even though they have abnormal treadmill exercise test.It is suggested that coronary angiography should be considered for these pectoris.
To these who have typical symptom of angina pectoris and abnormal treadmill exercise test but normal coronary angiography,the mechanisms of the disease was unclear.Microvascular angina and coronary arteries remodeling are relational.
引文
Onaka H,Hirota Y,Shimada S,et al.Clinical observation of spontaneous anginal attacks and multivessel spasm in variant angina pectoris with normal coronary arteries;evaluation by 24-hour 12-lead electrocardiography with computer analysis.J Am Coll Cardiol,1996, 27(1):38.
Desmarais RL ,Sarembock IJ .Elevated serum lipoprotein (a) is risk factor clinical recurrence after coronary balloon angioplasty.Circulation , 199591(5):1403-1409.
Lithell H.Insulin resistance and cardio vascular drug.Clin Exper Hypertension,1992.A14: 151.
Baumgart D,Haude M ,Liu FQ et al .Current concepts of coronary flow reserve for clinical decision making cardiac cat heterization . Am Heart J ,1998;136:137.
Houghton J ,Prisant M, Carr A et al .Relationship of left ventricular mass to impairment of coronary vasodilator reserve in hypertensive heart disease .Am Heart J, 1991;121:1107.
Bishop SP ,Powell PC, Hasebe N et al .Coronary vascular morphology in pressure-overload left ventricular hypertrophy.J Mol Cell Ca rdiol ,1996;28:141~154.
黄德嘉，章茂顺 李蕙，等.106例心律失常伴不典型心绞痛患者冠状动脉造影检查结果分析.中华心血管病杂志，1994，22（1）：32
Bonara E ,Kiechl S , Oberhollenzer F ,et al .Impaired glucose tolerance ,type 2 diabetes mellitus and carotid aatheroselerosis ; P ros pective results from the bruneck study .Diabetologia ,2000,43;156-1564.
The expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care ,2000,23;4-9.
Norman M .Clinical hypertension hypertension .sixth edition Baltimore, USA :Williams and Wilkins Company ,1994;90.
Luscher TF, Richard V Tschudim M, et al .Endothelial control of
vascular tone in large and small coronary arteries .J Am Coll Cardio 1990;15:519.
JuhanVI ,Alessi MC,Vague P.Increased plasma plasminogen activator inhibitor levels:a possible link between IR and atherothrboses. Diabetologia 1991;34:457.
Luscher TF,Richard V,schudim M,et al.Endothelial control of vascular tonein large and small coronary arteries.J Am Coll Cardiol,1990,15:519.
Kemp HG .left ventricular function in patients with the anginal syndrome and normal coronary arteriogram .Am J Cardiol,1973, 32(9);375.
Epstein SE ,Cannon RO .Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial coronary arteries J Am Coll Cardiol ,1986,8:459.
Attilio Maseri ,FRCP. Mechanism of angina pectoris in Syndrome X .JACC, 1991,17,499.
Cannon RO ,Camici PG,Epstein SE .Pathophysiological dilemma of syndrome X .Circulation ,1992,85:883~892.
Glagov S , Luo H, Eigler NL,et al .Contribution of inadequate compensatory enlargement to development of human coronary artery stenosis: an in vivo intravascular ultrasound study. N Eng J Med 1987;27(22):1371-1375.
Mintz GS, Kent KM, Pichard AD, Satler LF, Popma JJ, Leon MB. Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses: an intravascular ultrasound study. Circulation. 1997;95:1791-1798.
Iwami T. Nishioka T . Fishbein MC.et al. Coronary arterial remodeling in differing clinical presentations of unstable angina pectoris--an intravascular ultrasound study. Clinical Cardiology. 26(8):384-9, 2003 Aug.
Desmarais RL ,Sarembock IJ .Elevated serum lipoprotein (a) is risk factor clinical recurrence after coronary balloon angioplasty.Circulation , 199591(5):1403-1409.
Lithell H.Insulin resistance and cardio vascular drug.Clin Exper Hypertension,1992.A14: 151.
Baumgart D,Haude M ,Liu FQ et al .Current concepts of coronary flow reserve for clinical decision making cardiac cat heterization . Am Heart J ,1998;136:137.
Houghton J ,Prisant M, Carr A et al .Relationship of left ventricular mass to impairment of coronary vasodilator reserve in hypertensive heart disease .Am Heart J, 1991;121:1107.
Bishop SP ,Powell PC, Hasebe N et al .Coronary vascular morphology in pressure-overload left ventricular hypertrophy.J Mol Cell Ca rdiol ,1996;28:141~154.
黄德嘉，章茂顺 李蕙，等.106例心律失常伴不典型心绞痛患者冠状动脉造影检查结果分析.中华心血管病杂志，1994，22（1）：32
Bonara E ,Kiechl S , Oberhollenzer F ,et al .Impaired glucose tolerance ,type 2 diabetes mellitus and carotid aatheroselerosis ; P ros pective results from the bruneck study .Diabetologia ,2000,43;156-1564.
The expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care ,2000,23;4-9.
Norman M .Clinical hypertension hypertension .sixth edition Baltimore, USA :Williams and Wilkins Company ,1994;90.
Luscher TF, Richard V Tschudim M, et al .Endothelial control of
vascular tone in large and small coronary arteries .J Am Coll Cardio 1990;15:519.
JuhanVI ,Alessi MC,Vague P.Increased plasma plasminogen activator inhibitor levels:a possible link between IR and atherothrboses. Diabetologia 1991;34:457.
Luscher TF,Richard V,schudim M,et al.Endothelial control of vascular tonein large and small coronary arteries.J Am Coll Cardiol,1990,15:519.
Kemp HG .left ventricular function in patients with the anginal syndrome and normal coronary arteriogram .Am J Cardiol,1973, 32(9);375.
Epstein SE ,Cannon RO .Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial coronary arteries J Am Coll Cardiol ,1986,8:459.
Attilio Maseri ,FRCP. Mechanism of angina pectoris in Syndrome X .JACC, 1991,17,499.
Cannon RO ,Camici PG,Epstein SE .Pathophysiological dilemma of syndrome X .Circulation ,1992,85:883~892.
Glagov S , Luo H, Eigler NL,et al .Contribution of inadequate compensatory enlargement to development of human coronary artery stenosis: an in vivo intravascular ultrasound study. N Eng J Med 1987;27(22):1371-1375.
Mintz GS, Kent KM, Pichard AD, Satler LF, Popma JJ, Leon MB. Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses: an intravascular ultrasound study. Circulation. 1997;95:1791-1798.
Iwami T. Nishioka T . Fishbein MC.et al. Coronary arterial remodeling in differing clinical presentations of unstable angina pectoris--an intravascular ultrasound study. Clinical Cardiology. 26(8):384-9, 2003 Aug.