Clinical observational research on variant angina pectoris in China faces opportunities and challenges
-
摘要: 由冠状动脉(冠脉)严重痉挛(功能性闭塞)引起的变异型心绞痛(variant angina pectoris，VAP)在中国相当常见。由于理论认识不足和临床诊治经验不够丰富，致使漏诊、误诊甚至误治的情况时有发生。本文就VAP有关基本概念、基础理论、冠脉痉挛药物激发试验、VAP诊断标准、VAP与相关心血管疾病重大事件(急性心肌梗死、梗死后心绞痛、冠脉介入后自发性心绞痛、晕厥、心脏骤停及猝死等)的关系及VAP临床分型的价值等进行阐述，有助于解决临床工作中的实际问题，提高VAP的诊治水平，进一步推动对VAP的深入临床研究。Abstract: Variant angina pectoris(VAP) caused by severe spasm(functional occlusion) of the coronary artery is common in China. Due to lack of theoretical understanding and experience in clinical diagnosis and treatment, missed diagnosis, misdiagnosis and even mistreatment often occur. In this article, the basic concepts and theories of VAP, coronary spasm drug stimulation test, VAP diagnostic criteria, the relationship between VAP and major cardiovascular disease events(acute myocardial infarction, post-infarction angina pectoris, spontaneous angina pectoris after coronary intervention, syncope, cardiac arrest and sudden death, etc.) and the value of VAP clinical classification are expounded. It is helpful to solve the practical problems in clinical work, improve the level of diagnosis and treatment in VAP, and further promote the clinical research of VAP.
-
-
表 1 VAP患者临床分型参考
Table 1. Clinical classification of VAP patients for reference
参考条件1) 轻型 普通型 重型 危重型 VAP发作时病情感受度2) 轻微不适，一过性 不适，可耐受，多自行缓解 非常不适，难耐受，需药物治疗 异常不适，恐惧感、濒死感 VAP发作时脑部症状 无 不适，可耐受，多自行消失 头晕或黑朦 晕厥，心脏骤停复苏 VAP发作时重要体征 无 无 出汗乏力、面色苍白、血压升高 大汗淋漓、手足冰凉、血压下降 VAP发作时痉挛血管部位 单支 单支 单支或多支 多支或左主干 VAP发作时并发心律失常 无 无或常见心律失常 严重心律失常(过速或过缓型等) 致死性心律失常(室性心动过速或心室颤动等) 分型参考条件 具备全部5项 具备全部5项 具备5项中的2项 具备5项中的2项 注：1)参考条件：对VAP多次发作的患者，以最严重发作时所呈现的临床表现和检查结果为分型的参考条件；2)病情感受度：患者对反映病情严重程度的各种临床表现的自我感受和评估情况，如不适、可耐受、难耐受、濒死感等。 
下载: 导出CSV
-
[1] Teragawa H, Oshita C, Ueda T. Coronary spasm: it's common, but it's still unsolved[J]. World J Cardiol, 2018, 10(11): 201-209. doi: 10.4330/wjc.v10.i11.201
[2] Elbadawi A, Elgendy IY, Naqvis Y, et al. Temporal trends and outcomes of hospitalizations with Prinzmetal angina: perspectives from a national database[J]. Am J Med, 2019, 132(9): 1053-1061. doi: 10.1016/j.amjmed.2019.04.005
[3] 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. doi: 10.3969/j.issn.1004-8812.2015.04.001
[4] 赵普, 李牧蔚, 沈玉祥. 经皮冠状动脉介入治疗术后血管痉挛性心绞痛的病因及诊断方法的研究进展[J]. 中国心血管病研究, 2022, 20(3): 231-235.
[5] 沈玉祥, 赵康, 杨威, 等. 加强变异型心绞痛临床观察研究提高变异型心绞痛诊治水平[J]. 中华实用诊断与治疗杂志, 2023, 37(6): 548-556.
[6] 沈玉祥, 高传玉, 李牧蔚, 等. 对我国变异型心绞痛临床研究现状的几点看法[J]. 中华实用诊断与治疗杂志, 2021, 35(7): 649-652.
[7] Beltrame JF, Crea F, Kaski JC, et al. International standardization of diagnostic criteria for vaso-spastic angina[J]. Eur Heart J, 2017, 38(33): 2565-2568.
[8] Andreas Seitz MD, Rutger GT, Feenstra MD, et al. Acetylcholine rechallenge A First step toward tailored treatment in patients with coronary artery spasm[J]. JACC Cardiovasc Interv, 2022, 15(1): 65-75. doi: 10.1016/j.jcin.2021.10.003
[9] 陈修, 陈维洲, 曾贵云. 心血管药理学[M]. 北京: 人民卫生出版社, 1989: 20-21.
[10] 沈玉祥, 黄正文. 心血管疾病诊治现状与进展[M]. 郑州: 河南科学技术出版社, 1993: 45-58.
[11] JCS Joint Working Group, Guidelines for diagnosis and treatment of patients with vasospastic angina(Coronary Spastic Angina)(JCS2013)[J]. Circ, 2014, 78: 2779-2801.
[12] 陈灏珠. 实用心脏病学[M]. 5版. 上海: 上海世纪出版股份有限公司, 上海科技出版, 2016: 390-391, 856-866.
[13] 沈玉祥, 高传玉, 陈岩, 等. 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[J]. 临床心血管病杂志, 2016, 32(8): 781-785. doi: 10.13201/j.issn.1001-1439.2016.08.007
[14] Crea F, Bairey Merz CN, Beltrame JF, et al. Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization[J]. Eur Heart J, 2019, 40(29): 2455-2462. doi: 10.1093/eurheartj/ehy857
[15] Venkitachalam L, Kip KE, Mulukutla SR, et al. Temporal trends in patient-reported angina at 1 year after percutaneous coronary revascularization in the stent era: A report from the National Heart, Lung, and Blood Institute-sponsored 1997-2006 dynamic registry[J]. Circ Cardiovasc Qual Outcomes, 2009, 2(6): 607-615. doi: 10.1161/CIRCOUTCOMES.109.869131
[16] Niccoli G, Montone RA, Lanza GA, et al. Angina after percutaneous coronary intervention: The need for precision medicine[J]. Int J Cardiol, 2017, 248: 14-19. doi: 10.1016/j.ijcard.2017.07.105
[17] 沈玉祥, 赵香梅, 陈东昌, 等. 变异型心绞痛晕厥与痉挛靶血管部位、冠脉狭窄病变及心律失常关系的探讨[C]. 第34届长城心脏病学大会, 电子壁报, 2023, GW34-c0882.
[18] 陈东昌, 杨威, 李江, 等. 变异型心绞痛晕厥与痉挛靶血管部位及心律失常的关系[J]. 中华实用诊断与治疗杂志, 2019, 33(3): 250-253.
[19] Ledakowicz-Polak A, Ptaszynski P, Polak L, et al. Prinzmetal's variant angina associated with severe heart rhythm disturbances and syncope: a therapeutic dilemma[J]. Cardiol J, 2009, 16(3): 269-272.
[20] Bory M, Pierron F, Panagides D, et al. Coronary artery spasm in patients with normal or near normal coronary arteries: long-term follow-up of 277 patients[J]. Eur Heart J, 1996, 17(7): 1015-1021. doi: 10.1093/oxfordjournals.eurheartj.a014996
[21] Kobaynsh N, Hata N, Shinaura T, et al. Characteristics of patients with cardiac arrest caused by coronary vasospasm[J]. Circ J, 2013, 77(3): 673-678. doi: 10.1253/circj.CJ-12-0846
-