变异性心绞痛的临床特征、诊断评估、处置现状及预后分析

The Diagnosis and Treatment of Patients With Prinzmetal's Variant Angina

目的:了解变异性心绞痛(PVA)的临床诊治现状,加深对冠状动脉(冠脉)痉挛导致心肌缺血的认识,为临床及时诊断、避免误诊和漏诊,采取合理治疗提供依据。方法:收集我院2001-01至2011-01临床诊断的PVA患者30例,分析每例患者的临床特征、诊断和临床处置方法及随访结果。结果:本组中年男性多发,吸烟是最主要的危险因素。20例(66.7%)患者PVA发作呈昼夜节律性,13例(43.3%)患者伴有活动时心绞痛发作。PVA可发生心肌梗死、晕厥等严重并发症,通常发生在症状初发后的3～6个月内,远期预后良好。8例患者PVA发作时心电图呈现特征性的巨"R"波或"墓碑"波。PVA累及前降支为41.7%,右冠为45.8%,回旋支为12.5%。本组PVA发生于非显著性狭窄的冠脉和正常冠脉13例(占54.2%)。本组21例患者从PVA初发到确诊的时间在3个月之内,占70%。钙拮抗剂是PVA有效治疗的基石,但不能完全控制血管痉挛,60%以上的病例需要联合治疗。针对狭窄病变的介入治疗不是PVA治疗的有效治疗方法。结论:PVA在临床上的诊断仍然易被忽视,及时诊断是防止致命事件的关键,药物治疗是PVA的首选,对药物治疗失效的患者,介入治疗应在有选择的病例中进行。

Objective ：To study the current clinical features, diagnosis and treatment of Prinzmetal＇ s variant angina （PVA）in order to better understand myocardial ischemia caused by coronary artery spasm and to improve the management of patients with PVA. Methods：We retrospectively analyzed 30 PVA patients who were treated in our hospital from January 2001 to January 2011 with their clinical features, diagnosis, treatment and follow-up prognosis. Results：PVA patients had more male gender and smoking history. There were 20 （66. 7% ）cases had a circadian rhythm upon the onset,13（43.3% ）had angina pectoris induced by physical efforts. PVA could be complicated with myocardial infarction, syncope and sudden cardiac death which usually happened at 3 to 6 months after the onset. 8 patients had the characteristic of giant＂ R＂ wave or＂ tombstone＂ wave in ECG. Coronary angiography indicated that PVA involved vessels were left anterior de- scending artery（ LAD ,41.7% ） ,right coronary artery（ RCA ,45.8% ） and left circumflex artery（ LCX, 12. 5% ） respectively. PVA usually occurred in non-significant stenotic coronary artery and normal coronary artery（ 13 cases,54. 2% ）. It usually took about 3 months from the first attack to clear diagnosis. Calcium antagonists were the basic treatment for PVA, more than 60% of patients required combined medication. PCI was not the effective treatment for PVA stenosis. Conclusion：PVA might be overlooked in clinical practice, early diagnosis was the key to prevent fatal events. Medication was preferred in most patients and PCI could be performed only in certain selected cases.