心肌桥合并冠状动脉痉挛患者的临床特点

Clinical features of coronary artery spasm patients with or without myocardial bridge

目的探讨心肌桥合并冠状动脉痉挛患者的临床特征及其与血管内皮细胞功能的关系。方法接受冠状动脉痉挛激发试验的118例患者，根据冠状动脉造影显示是否合并心肌桥分为肌桥组（n=26）和非肌桥组（n=92），比较两组乙酰胆碱试验、运动心电图、核素灌注心肌显像负荷试验的结果及血浆内皮素1和一氧化氮水平。结果肌桥组乙酰胆碱试验阳性21例（81％），非肌桥组乙酰胆碱试验阳性52例（57％，P〈0．05）；心电图运动试验阳性者两组分别为19例（73％）和7例（8％，P〈0．001），核素灌注心肌显像负荷试验显示缺血性改变者两组分别为20例（77％）和9例（10％，P〈0．001），反相再分布分别为23例（88％）和68例（74％，P〉0．05），两组患者的临床症状发作特点亦显著不同，肌桥合并痉挛患者的内皮素水平明显增高[（132．1±6．5）ng／L比（108．5±8．2）ng／L，P〈0．01]，而一氧化氮水平明显降低[（84．7±17．5）ng／L比（99．8±18．2）ng／L，P〈0．05]。结论心肌桥患者易发生冠状动脉痉挛，可能与血管内皮细胞功能紊乱有关，该类患者多具有特征性的临床表现和心脏负荷试验结果。

Objective To investigate the clinical features of coronary artery spasm patients with or without myocardial bridge and explore the roles of endothelial dysfunction in these patients. Methods One hundred eighteen patients undergone acetylcholine provoking test were divided into myocardial bridge （MB） group （n = 26） and non-myocardial bridge （ NMB ） group （ n = 92 ）. The results of acetylcholine test, treadmill exercise electrocardiography, stress myocardial perfusion scintigraphy, plasma level of endothelin-1 and nitric oxide were compared between MB group and NMB group. Results Coronary artery spasm was induced in 21 patients in MB group （81%） and 52 patients in NMB group （57%, P 〈 0. 05 ）. Positive treadmill electrocardiography was obtained in 19 patients in MB group （73%） and 7 patients in NMB group （8%, P 〈0. 001 ）. Ischemic perfusion defect in 20 （77%） and 9 patients （ 10% , P 〈0. 001 ） and reverse redistribution in 23 （88%） and 68 patients （74%, P 〉 0. 05 ）. Patients showed different clinical features in MB group and NMB group （more short-duration exertional angina and could not be readily released by nitroglycerine in MB group while more patients experienced long-lasting variant angina and symptoms could be readily released by nitroglycerine）. Plasma endothelin-1 level was significantly higher [ （ 132.1 ± 6. 5 ） ng/L vs. （ 108.5 ± 8. 2 ） ng/L, P 〈 0. 01 ] while nitric oxide was significant lower[ （84. 7 ± 17.5 ） ng/L vs. （99.8± 18.2）ng/L, P 〈 0.05 ] in MB group compared to NMB group. Conclusion MB patients were prone to coronary artery spasm partly due to endothelial dysfunction. Patients with MB and coronary artery spasm also showed classic clinical symptoms and positive stress tests for ischemia.