一种特殊类型的心绞痛——走过心绞痛的临床特征及发病机制探讨

Clinical characteristics and pathogenesis of walk-through angina pectoris——a special type of angina

目的探讨一种特殊类型的心绞痛——走过心绞痛的临床特征及其发病机制。方法连续观察和记录住院冠心病心绞痛患者1334例,所有患者均仔细询问心绞痛发作病史及经冠状动脉造影(CAG)检查,其中17例患者符合走过心绞痛的诊断,总结其临床特征、记录心电图变化、并根据CAG结果选择进一步治疗方案。结果与临床一般心绞痛相比,走过心绞痛很容易被误诊和漏诊,本次住院前误诊和漏诊率为100%;CAG结果显示冠状动脉单支病变8例,2支病变7例,3支病变2例;所有病例均有明显的侧支循环形成;全部17例患者中13例(76%)需要进一步血运重建,其中9例采取了冠状动脉介入治疗,4例采取了冠状动脉搭桥术;另4例采取了单纯药物保守治疗。结论走过心绞痛患者的心绞痛发作症状极不典型,即活动开始时出现心绞痛的症状,但随着活动的继续,心绞痛症状非但不加重反而逐渐消失,加之心电图未出现典型缺血性变化,因此在临床上极容易被误诊和漏诊;另一方面,此类患者冠状动脉狭窄程度重,冠状动脉侧支循环形成明显,大部分患者需要进一步血运重建。侧支循环与缺血预适应均参与了走过心绞痛的发病机制。

Objective：To explore the clinical characteristics and its pathogenesis of a special type of anginawalk-through angina. Method： The 1334 inpatients with angina pectoris of coronary atherosclerosis disease were observed and recorded continueously. History of angina onset was inquired carefully and coronary artery angiography （CAG） was performed for all patients. Of the patients, seventeen were diagnosed as walk-through angina. Its clinical characteristics were summaried and electrocardiography changes were recorded. Advanced treatment measures were selected based on the results of CAG. Result：The results of CAG indicated that eight patients manifested with single branch lesions and seven patients with two branch lesions and two patients with three branch lesions as well as all patients were found with obvious collateral circulation. Of the patients, thirteen （76%） need further revascularization （nine patients with percutaneous coronary artery intervention and four patients with coronary artery bypass graft） and four （24%） were administrated conservative therapy based on the results of CAG. Conclusion：Walk-through angina is a special type angina which is unfamiliar to us. Its clinical characteristics include that the chest pain appearea when patients began exertion and diseppeared graduately with exertion continue. Changes are not manifest in electrocardiography. So the situation is misdiagnosed and missedly diagnosed easily. The lesions of the patients are more severe and all patients have striking collateral circulation and the majority of the patients need further revascularization. In conclusion, to identify patients with walk-through angina is of vital clinical significance.