单中心192例变异型心绞痛的临床分析

The clinical analysis of 192 patients with variant angina in single center

目的探讨变异型心绞痛的临床特点及发病机制。方法回顾性分析5年内我院住院患者中192例确诊为变异型心绞痛患者(未行激发试验)的临床资料。结果变异型心绞痛临床上少见,好发于男性,占85.9%,合并危险因素包括吸烟、高血压、饮酒,有过敏史16.7%。心绞痛的好发时间为夜间及凌晨。35例(18.2%)心绞痛发作时合并心律失常,其中室性心动过速11例(5.7%)、心室颤动6例(3.1%)、窦性心动过缓7例(3.6%)、三度房室传导阻滞6例(3.1%);56.9%患者存在冠状动脉固定狭窄,17例(8.9%)合并冠状动脉肌桥。结论变异型心绞痛是冠状动脉痉挛导致的心肌缺血,常合并恶性心律失常,可导致急性心肌梗死甚至猝死。对于狭窄程度严重者应行支架置入术。

Objective To assess the clinical manifestation and mechanism of variant angina. Method The clinical data of 192 patients with variant angina were analyzed retrospectively. Results The disease is uncommon in clinic. It affected men （85. 9%） more frequently than women, the common risk factors included smoking,hypertension and alcohol drinking,and 16.7 % patient had allergy history. Chest pain usually occurred at midnight and in early morning, and responded well to sublingual nitroglycerin. Thirty-five（18.2 %）patients suffered from serious arrhythmia including ventricular tachycardia （11 patients, 5.7 % ）, ventricular fibrillation （6 patients, 3.1%）, sinus bradycardia（7 patients,3.6%）and m-degree AV block（6 patients, 3. 1%）during chest pain. Significant fixed coronary obstruction occurred in 56.9% patients,and 17（8.9%） patients accompanied with coronary myocardial bridge. Nitrates, calcium antagonists and placement of stents were extremely effective in preventing variant angina. Conclusions Variant angina is caused by coronary spasm and usually accompanied with serious arrhythmia. It can cause myocardial infarction and sudden cardiac death without treatment promptly. Placement of stents in the coronary arteries with severe fixed obstruction is helpful.