变异型心绞痛的临床特征和诊治分析

Clinical Features, Diagnostic and Treatment Assessment of Patients with Variant Angina

目的总结变异型心绞痛的临床特征和诊断治疗状况。方法回顾性分析我院连续住院172例变异型心绞痛患者的临床特征、诊断方法和治疗措施。结果患者平均年龄50.7±9.9岁(男:女=8.6),75%的患者有吸烟史。确诊所需时间中位数为2.5个月,确诊时间≥6个月占43%。22.1%患者伴发心律失常,以缓慢性心律失常为主。155例行冠状动脉造影检查,冠状动脉无显著狭窄74例(47.7%),单支、双支和三支病变分别为47例(30.3%)、24例(15.5%)和10例(6.5%)。138例有心绞痛发作时心电图并行冠状动脉造影,冠脉痉挛发生在造影显示完全正常的冠脉占49.3%,发生在具有显著狭窄病变(≥50%)的冠脉占39.9%,右冠脉易发生痉挛。56例(32.6%)行介入或冠状动脉搭桥治疗,158例(91.9%)联合硝酸酯类和钙拮抗剂治疗。结论变异型心绞痛仍是易忽视的疾病,约50%患者冠状动脉正常,右冠状动脉痉挛更常见,治疗以药物为主。

Objective To assess clinical features, diagnostic and treatment methods of patients with variant angina. Methods 177 patients were diagnosed variant angina at our institute. Detailed clinical findings were retrospectively collected for each patient. Results Mean age was 50.7±9.9 years （male： female=8.6）. 75% of patients had smoking history. The median time from the first angina attack to diagnosis was 2.5 months, with diagnosis requiring ≥ 6 months in 43% of patients. 22.1% of patients accompanied with arrhythmias, most often in bradycardia. Coronary angiography （n=155） showed no significant coronary stenosis in 47.7% of patients, with 1-vessel disease in 30.3%, with 2- or 3- vessel disease in 22%. 49.3% of patients had completely normal coronary arteriograms, 39.9% had significant coronary disease （≥ 50%）. Right coronary artery occurred frequently vasospasm. Percutaneous coronary interventions or coronary artery by-pass graft surgery was performed in 56 patients （32.6%）. 158 patient（s91.9%） received nitrates and calcium-channel blockers. Conclusions Our data suggest that Chinese variant angina is still frequently overlooked diagnosis. Coronary artery in about half patients show normal, most patients take medicine.