变异型心绞痛100例的临床特点与冠状动脉病变的对照分析

沈玉祥; 高传玉; 陈岩; 李牧蔚; 朱中玉; 张静; 徐予; 张嘉莹; 李江; 刘晓宇; 陈东昌

doi:10.13201/j.issn.1001-1439.2016.08.007

变异型心绞痛100例的临床特点与冠状动脉病变的对照分析

- 河南省人民医院郑州大学人民医院心内科(郑州, 450003)
基金项目:
河南省医学科学攻关项目(No:2006-0131)

详细信息

通讯作者: 沈玉祥,E-mail:syxchn@163.com

中图分类号: R541.4

收稿日期: 2016-01-15

Comparative analysis of clinical features and coronary angiography in 100 patients with variant angina pectoris

- Department of Cardiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China

More Information

Corresponding author: SHEN Yu-xiang, E-mail: syxchn@163.com

Received Date: 15 January 2016

摘要

摘要: 目的: 探讨变异型心绞痛(VAP)患者的主要临床特点与冠状动脉(冠脉)造影病变的关系。方法: 收集我院1980-06-2015-06VAP患者150例,对资料完整的100例进行临床特点和冠脉造影病变的对照分析。结果: ①男86例,女14例,男女比例为6.1∶1;男女的平均年龄分别为(50.6±10.6)岁与(52.0±11.6)岁(P>0.05);除16例冠脉正常者外,余84例不同狭窄程度的冠脉组之间,其平均年龄未显示明显差异(P>0.05)。②16例冠脉正常的VAP患者中,心绞痛发作形式为单纯型者13例(81%),混合型者3例(19%);有不同程度冠脉狭窄病变的84例中,单纯型48例(57%),混合型36例(43%)。冠脉病变与发作形式之间,未显示规律性关系。③100例中,检出心律失常54例,检出率为54%;左、右冠脉痉挛组中,心律失常检出率分别为47%与67%(P>0.05);54例心律失常中,缺血性、再灌注性及双期性心律失常的检出率分别为79.6%、16.7%及3.7%;右冠痉挛组的缺血性心律失常发生率(90%)高于左冠痉挛组(70%)(P<0.05);100例不同狭窄程度的冠脉组之间,其心律失常的检出率也未显示出明显的关系(P>0.05)。④晕厥13例。左、右冠脉痉挛组中,晕厥发生率分别为5.3%与23.3%(P<0.05);13例晕厥病例中,缺血性心律失常12例(92.3%),明显高于再灌注性心律失常1例(7.7%)。结论: 本组100例VAP中以中年男性为常见,多数以清晨(单纯型)发作为特点;VAP发作时54%的患者可检出心律失常;右冠脉痉挛导致的缺血性心律失常发生率较高,右冠脉痉挛所引起的缺血性缓慢性心律失常是引起晕厥的主要原因。年龄(除16例冠脉正常者外)、心绞痛的发作形式及心律失常的检出率与冠脉狭窄病变的程度未显示出明显的关系。
- 变异型心绞痛 /
- 冠脉痉挛 /
- 冠脉造影 /
- 心律失常 /
- 晕厥
Abstract: Objective: To investigate the relationship between the main clinical features and coronary angiography in patients with variant angina pectoris(VAP).Method: We collected 150 patients diagnosed as VAP.We analyzed the clinical features and coronary angiography in 100 patients with VAP who had full data.Result::①There were 86males(86%)and 14females(14%),male vs.female was 6.1:1in 100 cases.The average age of males vs.females was 50.6±10.6years vs.52.0±11.6years(P>0.05).The average age had no significant statistically difference among each subgroup of 84 cases who had different degrees stenosis,excluding 16 cases with normal coronary arteries(P>0.05).②There were 13cases(81%)pure VAP type,while 3cases(19%)mixed VAP type in 16 cases with normal coronary arteries.There were 48cases(57%)pure VAP type,while 36cases(43%)mixed VAP type in 84 cases with different degrees stenosis.No regular relationship had been found between coronary artery stenosis and VAP type.③54cases(54%)arhythmia were detected in 100 VAP cases.The arhythmia detected rate were 47%and 67%respectively in left coronary artery spasm group and right coronary artery spasm group(P>0.05).The arhythmia detected rate were 79.6%,16.7% and 3.7% respectively in ischemic type,reperfusion type and dual-phase type.The arhythmia detected rate of ischemic type in right coronary artery spasm group(90%)higher than in left coronary artery spasm group(70%)(P<0.05).The arhythmia detected rate were no significant statistically difference among each subgroup of 100 cases who had different degrees stenosis(P> 0.05). ④ There were 13 syncope cases in all 100 VAP cases. The syncopic rates were 5.3% and 23.3% respectively in left coronary artery spasm group and right coronary artery spasm group(P<0.05).The syncopic rate was obviously higher in the ischemic type of 12cases(92.3%)than in the reperfusion type of 1case(7.7%)in the 13 cases of syncope.Conclusion::VAP is more common in mid-aged males in the 100 VAP cases.The clinical feature is easily attack at early morning(particularly pure VAP type).The arrhythmia rate detected is 54%.The ischemic arrhythmia is more frequently which is caused by the right coronary artery spasm.The main cause of syncope is the slow arrhythmias by the right coronary artery spasm.There is no obviously relationship among age(exclude 16 cases with normal coronary arteries),attack type of VAP,detected rate of arrhythmia and the coronary artery stenosis.
- variant angina pectoris /
- coronary arteries spasm /
- coronary angiography /
- arrhythmias /
- syncope

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参考文献(14)

[1]	向定成,曾定尹,霍勇,等.冠状动脉痉挛综合征诊断与治疗中国专家共识[J].中国介入心脏病学杂志,2015,23(4):181-186.
[2]	沈玉祥,高传玉,黄克钧,等.冠状动脉痉挛的心电图改变及其临床意义[J].河南医学研究,2005,14(1):35-37.
[3]	ZHU C G,LI J J,XU Y L,et al.Gender difference of clinical characteristics in Chinese patients with spontaneous variant angina[J].Chin Med J,2010,123:1377-1381.
[4]	FIGUERAS J,DOMINGO E,FERREIRA I,et al.Persistent angina pectoris,cardiac mortality and mycardicalInfarction during a 12year follow-up in 271variant angina patients without significant fixed coronary stenosis[J].Am J Cardiol,2012,110:1249-1255.
[5]	向定成,何建新,洪长江,等.非典型性冠状动脉痉挛患者的临床特点及近期预后[J].中华心血管病杂志,2006,34(3):227-230.
[6]	YASUE H,NAKAGAWA H,ITOH T,et al.Coronary artery spasm-clinical features,diagnosis,pathogenesis,and treatment[J].J Cardiol,2008,51:2-17.
[7]	TAKAGI Y,YASUDA S,TSUNODA R,et al.Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest:multicenter registry study of the Japanese Coronary Spasm Association[J].Circ Arrhythm Electrophysiol,2011,4:295-302.
[8]	黄立萍,董颖雪,洪丽,等.62例变异性心绞痛患者动态心电图分析[J].大连医科大学学报,2012,34(4):359-362.
[9]	沈玉祥,高传玉,黄克钧,等.变异性心绞痛临床表现与冠脉造影的对照分析[J].河南医学研究,2006,15(1):32-34.
[10]	SUEDA S,SUZUKI J,WATANABE K,et al.Clinical characteristics of female patients with coronary spastic angina:comparison with male patients[J].Jpn Circ J,2000,64:416-420.
[11]	祁哲,陈纪林,刘丽,等.变异型心绞痛发作时心律失常的发生与冠状动脉病变的关系[J].中华心律失常学杂志,2002,6(3):155-156.
[12]	CHU G,ZHANG G B,ZHANG Z,et al.Clinical outcome of coronary stenting in patients with variant angina refractory to medical treatment:a consecutive single-center analysis[J].Med Princ Pract,2013,22:583-587.
[13]	KISHIDA H,TADA Y,FUKUMA N,et al.Significant characteristics of variant angina patients with associated syncope[J].Jpn Heart J,1996,37:317-326.
[14]	LEDAKOWICZ-POLAK A,PTASZYNSKI P,POLAK,et al.Prinzmetal's variant angina associated with severe heart rhythm disturbances and syncope:a therapeutic dilemma[J].Cardiol J,2009,16:269-272.