变异性心绞痛临床表现与冠脉造影的对照分析

Control analysis of clinical manifestation and coronary angiography in patients with variant angina.

目的：探讨变异型心绞痛患者临床表现与冠状动脉病变的关系。方法：对30例确诊为变异型心绞痛的患者进行冠脉造影。以冠脉有无病变及病变情况与临床表现作对比分析。结果：①30例中，冠脉正常者9例，均为男性，平均年龄42．0±7．4岁；21例有冠脉病变者男17例，女4例（男：女=4．3：1），甲均年龄50．3±10．5岁，两组平均年龄比较有显著差异（P〈0．05）。②21例有冠脉病变者其狭窄程度在20％～95％。前降支单支病变13例（占62％），其中50％以下狭窄4例，50％～70％狭窄2例，70％以上狭窄7例；右冠单支病变2例，50％以下和50％。70％狭窄各1例；双支（前降支并右冠）病变3例；三支病变3例。③心绞痛发作时及其消退过程中，9例冠脉造影正常者检出心律失常4例（检出率44％）；21例有冠脉病变者检出心律失常12例（检出率57％）。④变异型心绞痛发作时，胸前各导联ST-T改变者15例，其中13例为前降支单支病变，二者符合率达87％，高于下壁各导联ST-T改变者（6例）与右冠脉病变（2例）的符合率33％。结论：①在变异型心绞痛患者中，中年男性较多。与冠脉有病变者相比，冠脉正常的患者发病年龄趋早，其发作时心律失常的检出率偏低（44％与57％）。②变异型心绞痛发作时，心电图sST-T改变的导联部位与其相关的冠状动脉痉挛有关。③本组30例患者尚未发现性别、年龄、病程、心绞痛易发时间及其持续时问与冠脉病变的明显关系。

Objective： To approach the relationship of the clinical manifestation and the condition of coronary artery in patients with variant angina. Methods ： Routine coronary angiography was performed on thirty patients with defined variant angina. The lesions of coronary artery and the clinical manifestation were contrasted and analysed. Results： ①Among 30 patients, 9 with normal coronary artery were all male, mean age was 42.0 ± 7.4 years old; 21 with coronary arterial stenosis include 17 male and 4 female（male： female = 4.3：1 ）, mean age 50.3 ± 10.5 years old. The difference in mean ages of the two groups was significant（ P 〈 0.05） . ②The degree of coronary arterial stenosis of 21 patients was from 20% to 95%. Among 13 with single LAD stenosis（62% ）,the extent of stenosis of 3 patients was less than 50 percent, 2 patients 50-70 percent, 7 more than 70 percent; in 2 with single RCA stenosis, 1 less than 50 percent, 1 patients 50-70 percent; 3 with two branches stenosis （LAD and RCA） ; 3 with three branches stenosis. ③In the process of its onset and relief, 4 patients with arrhythmia were found in 9 with normal coronary artery （44%）. 12 in 21 patients with coronary artery stenosis （57%）. ④ During variant angina attacking, 13 were single LAD stenosis of 15 with precordial leads ST-T changes. The coincidence was 87 percent （13/15）, higher than that of inferior leads ST-T changes and RCA stenosis 33 percent （2/6）. Conclusion： ①In patients with variant angina, the middle-aged male are more than others. The age of onset in patients with normal coronary artery is earlier than that with coronary artery stenosis, and the detection rate of arrhythmias is lower（44% vs 57%）. ②The leads with ST-T changes are relevant to the related coronary artery spasm. ③We did not find the obvious relation between coronary artery stenosis and sex,age,course,attacking time and duration of angina.