变异型心绞痛患者冠状动脉痉挛与血管狭窄病变的关系

THERELATIONBETWEENCORONARYVASOSPASMANDCORONARYOBSTRUCTIVELESIONSINPATIENTSWITHVARIANTANGINA

为了探讨冠状动脉（冠脉）痉挛与冠脉病变间的关系，对３８例变异型心绞痛患者的冠脉造影资料进行了分析。结果显示，冠脉痉挛发生在造影显示完全正常的冠脉占２６．３％，发生在具有严重狭窄病变（≥５０％）的冠脉占６３．２％。在后者中，当缺血相关血管的狭窄达到７５％～９０％时，其痉挛的发生率最高。在冠脉痉挛的分布方面，前降支痉挛的发生率（６５．８％）明显高于右冠脉（２６．３％）和旋支（５．３％），但在冠脉无明显狭窄（＜５０％）病变的患者中，前降支痉挛的发生率（５０．０％）仅略高于右冠脉。提示冠脉痉挛多发生在具有严重狭窄病变的前降支。

Aseriesof38patientswithvariantanginainwhomcoronaryarteriographywasper-fomedwasreviewedtoinvestigatetherelationbetweencoronaryvasospasmandcoronaryobstructivele-sions.10ofthe38(26.3%)patientshadcompletelynormalcoronaryarteriograms;4(10.5%)hadin-significantcoronaryarterydisease(<50%stenosis);24(63.2%)hadsignificant(≥50%stenosis)coronaryarterydisease,includingsinglevesseldiseasein12cases,multiplevesseldiseasein11casesandleftmaintrunkdiseaseinonecase.Theresultsofthisstudyshowedthattheincidenceofcoronaryvasospasmincreasedwiththeseverityofcoronarystenosisandwashighestat75%～90%stenosisoftheischemia-relatedarteryinthosepatientswithsignificantcoronarydisease.Inthisstudyof38pa-tients,coronaryvasospasminvolvedtheleftanteriordescendingartery(LAD)in25patients(65.8%),rightcoronaryartery(RCA)in10(26.3%)andleftcircumflexartery(LCX)in2(5.3%),butinpa-tientswithinsignificantstenosis(<50%),LADwasinvolvedin50.0%,RCAin42.9%andLCXin7.1%.TheseresultsindicatethatcoronaryvasospasmoccursfrequentlyinpatientswithseverestenosisoftheLAD.