高血压和非高血压冠脉造影正常患者胸痛的临床特点分析

Analysis of The Clinical Characteristics in The Chest Pain Patients of ypertension and Non-hypertension Without Coronary Steno-sis

目的 分析高血压和非高血压冠脉造影正常但临床有胸痛表现患者的特点.方法 本组共160例,高血压组71例,非高血压组89例.均因胸痛胸痛怀疑冠心病而行心电图及冠状动脉造影检查,部分病人作了运动试验,心得安试验及超声心动图指标.结果 两组相比,高血压组的胸痛多为典型的劳累型心绞痛(与非高血压组相比P<0.01),β阻滞剂为主的抗心绞痛治疗常有效;静息心电图表现为左室劳损及冠状T波,运动试验多阳性(P<0.01);左室舒张末期内径、室间隔厚度及左室后壁厚度与非高血压组有明显的差别(与非高血压组相比p均<0.05);冠状动脉迂曲、僵硬.结论(1)高血压伴心绞痛的患者中有相当一部分无造影可见的冠状动脉狭窄;(2)高血压而无冠脉狭窄病变病人的胸痛以典型的劳累型心绞痛多见,可出现冠状T波,运动试验多阳性,心室肥厚,冠脉迂曲、僵硬,易发生冠脉痉挛,以及对β阻滞剂为主的抗心绞痛治疗反应较好;(3)相对于非高血压的病人,高血压患者在发生胸痛时更需要用冠状动脉造影来鉴别其是否有真正的冠状动脉粥样硬化性心脏病.

Subjective To analyze the clinical caracteristics in the chestpain patients of hypertension and non-hypertension who had no coronary stenosis defined with coronary angiography. Methods There were 160 cases in this study, 71 cases in hypertension group and 89 cases in non-hypertension group. All the patients received coronary angiography and rest electrocardiography (ECG), and part of them did exercise test, proranolol ECG test and echocardiography examination because of suspected angina. Results (l)All the patients with chest pain had no coronary stenosis. (2) Most of the patients in hypertension group suffered stable angina and had a good response to β-blockers(vs non-hypertension group, P<0. 01 and 0. 05 respectively). The rest ECG showed strain left ventricular hypertrophy and coronary T waves, and exercise test produced a positive results more easily. (3) There were significantly differences between the two groups in end diastolic dimension(EDD), inerventricular septum(IVS) and posterior wall(PW) (vs non-hypertension group P<0. 05). (4) The coronary arteries of hypertension patients had more branches, and the arteries were more tortuous and stiff. Conclusions (l)Many patients of hypertension who suffered angina may not be caused by coronary stenosis. (2) The causes of the angina of the hypertension patients may be left ventricular hypertrophy or others. β-blockers can relief this kind of chest pain effectively. (3) Coronary angiography is necessary for identifying the hypertension-chest pain from real coronary heart disease.