冠脉造影正常的胸闷痛伴ST段或T波异常患者的病因分析

Etiological factors in chest distress or chest pain cases with ST segment or T wave abnormality but with normal coronary arteriongraphy

目的探讨冠状动脉造影正常但具有典型胸闷痛且伴ST段或T波异常改变患者的病因及其相关性。方法选择45例胸闷、胸痛,或同时有胸闷痛症状且伴明显ST段、T波,或ST-T异常改变患者(其中仅有胸闷者15例,典型胸痛者20例,胸闷胸痛均有者10例),冠脉造影结果采用目测法,狭窄≥50%者诊断为冠心病。结果45例患者除2例右冠脉轻度狭窄20%-30%,2例左前降支轻度狭窄25%-35%外,余冠脉均未见明显狭窄等异常。结论冠脉造影有其不足的一面,它对狭窄程度的判断依赖于与邻近的"正常"血管节段的对比,不能发现微血管的病变。不典型胸痛患者冠心病发病率较低,单凭ST段、T波或ST-T的异常改变作为冠心病的诊断标准不具特异性。

Objective To study the etiological factors and their correlations in chest distress or chest pain cases with ST segment or T wave abnormality but with normal coronary arteriongraphy（CAG）. Methods 45 cases with chest distress or chest pain or both, as well as with an obvious ST segment or T wave or ST - T abnormality were enrolled into in our study, of which 15 cases with only chest distress, 20 cases with a typical chest pain, and 10 cases with both. The CAG results were interpreted by ocular estimatimation, and stenosis more than 50% was diagnosised as coronary artery disease（CAD）. Results There are 2 with a slight 20% - 30% stenosis in right coronary and 2 with a 25% -35% stenosis in left anterior descending branch, and the others were normal. Conclusion CAG has its insufficience, its judgement on coronary artery stenosis degree depends on a contradistinction with blood vessels nearby, so it is hard to discover the pathological changes of the micro blood vessels. Cases with atypical chest pain have low incidence rates of CAD, it has no specificity to diagnose a case to be CAD by abnormality of ST segment, T wave or ST -T only.