117例女性胸痛患者临床特点分析

The clinical characteristics of 117 women with chest pain

目的分析女性胸痛患者的临床特征及冠状动脉造影的特点.方法对我院2000至2004年117例因胸痛入院行冠状动脉造影的女性患者的临床资料及冠状动脉造影结果进行回顾性分析.结果患者平均年龄(68.79±10.27)岁,确诊为冠心病78例,排除39例.典型临床症状的阳性预测值为68%,绝经期后合并高血压、糖尿病发病率高、脂蛋白(Lp)(a)水平较高、血脂、吸烟和家族史对冠心病的预测价值更有意义,围绝经期的4例冠心病均是糖尿病患者.78例冠心病患者中,单支病变18例(23%),2～3支病变57例(73%);简单斑块13例(17%),复杂斑块62例(79%),未见斑块3例(4%).无创检查中常规心电图、运动试验、超声心动图的阳性预测值分别为74%、90%、95%,准确性分别为70%、59%、74%.结论女性冠心病多见于绝经后的中、老年人群,围绝经期人群中除非伴有糖尿病,通常发病率低,血管病变以多支和复杂斑块的血管病变为主.对并存高血压、糖尿病和Lp(a)水平较高的胸痛患者即使无创检查未发现异常也应尽早行冠状动脉造影检查以明确诊断.

Objective To analyse the characteristics of clinical data and coronary angiography in women with chest pain. Methods From 2000 to 2004, 117 females with chest pain underwent coronary angiography study in our hospital, with age range 43-89 years old, （mean 68. 79±10.27） years, including 78 patients with coronary heart disease （CHD）. Results The positive predicting value of typical chest pain was 68%. The higher significance in predicting value of CHD were post menopause.hypertention,type-2 diabetes and lipoprotein（a）[Lp（a）] than hyperlipidemia ,smoking and family history, including 4 perimenopause women with CHD were all diabetic patients. 18 patients had single-vessel coronary disease （23%）, 57 multivessel coronary disease （73%）, The positive predicting values of noninvasive test included electrocardiography （ECG）, treadmill exercise test （TET） and echotrocardiography （UCG） were 74 %, 90 % , 95 % and the accuracy rates were 70 %. 59 %, 74 % respectively. Conclusion Women with CHD occur mostly after menopause, perimenopause women were in low incidence of CHD unless intercurrent with diabetes. The vascular lesions were mainly involved multivessels and complicated lesions. Plaque formation patients with normal noninvasive test but associated with chest pain accompanieal hypertension, diabetes and high Lp（a）, should have coronary angiography for correct diagnosis. （Shanghai Med J, 2005,28：685-688）