非动脉粥样硬化性冠状动脉病变的临床特点及2a随访

Clinical analysis of non-atherosclerotic coronary artery diseases and 2 years follow-up

目的探讨非动脉粥样硬化性冠状动脉病变的临床特点及其2 a随访结果。方法回顾性总结967例18～45岁有冠状动脉病变的患者,从中最终筛选出24例非动脉粥样硬化的患者进行临床分析。结果 (1)24例(2.48%)患者男女之比为7∶5,平均年龄(41.62±2.68)岁。(2)女性与男性相比,起病至首诊时间长(男性首诊时间中位数为0.25个月,女性为7.50个月,P<0.05),初发心绞痛的发生率低(男性为42.86%,女性为0.00%,P<0.05),心肌梗死及节段性室壁运动异常发生率低(男性为50.00%,女性为10.00%,P<0.05),左心室舒张末期内径(LVEDD)小[男性为(51.83±7.51)mm,女性为(44.90±4.58)mm,P<0.05]。(3)18～40岁与41～45岁2个年龄段比较,病情特点相同。在41～45岁患者中,男性患者心肌梗死发生率高(男性为50.00%,女性为0.00%,P<0.05)、LVEDD扩大[男性为(51.56±5.05)mm,女性为(46.14±4.30)mm,P<0.05]。(4)冠状动脉病变以单支病变为主,其中左前降支病变占全部病例的50.00%。(5)24例患者行经皮冠状动脉介入治疗后均获得临床缓解。住院期间及2 a随访均无主要心血管不良事件发生。(6)3例患者在2 a随访中接受了风湿性疾病的筛查,其中2例诊断为系统性血管炎且病变处于稳定期。结论非动脉粥样硬化性冠状动脉病变在临床上并不罕见,多数在40岁左右发病。与传统冠状动脉粥样硬化性心脏病(简称冠心病)相比,女性患者相对比例提高;女性起病较隐匿,病情相对较轻;病情轻重与患者年龄无关;冠状动脉病变以单支病变为主。按照常规冠心病行药物、经皮冠状动脉介入治疗后短期疗效好。推测部分患者病因可能为系统性血管炎所致。对于怀疑有冠状动脉病变的中青年女性,建议排除非动脉粥样硬化性病变。

Objective To investigate the clinical characteristics of non-atherosclerotic （NA） coronary artery disease （CAD） and the result of 2 years follow-up. Methods Twenty-four patients with NA-CAD among 967 patients with coronary artery disease aged between 18 and 45 years were selected and retrospectively analyzed. Results （ 1 ） Ratio of male （M） and female（F） was 7 ： 5 in 24 patients （2.48% of 967 patients）, the average age was （41.62 ±2.68 ） years. （2） In female group, the period from onset to be diagnosed clearly was longer than that in male group（42.86% vs 0.00% ,P 〈 0.05 ）. The incidence of myocardial infarction（MI） or segmental wall motion abnormalities was lower in female group than that in male group （ 10.00% vs 50.00% , P 〈 0. 05 ） , the left ventrieular end diastolic dimension （LVEDD） in female group was shorter than that of male group [ （44.90 ±4.58 ） mm vs （ 51.83 ±7.51 ） mm, P 〈 0.05 ]. （ 3 ） They shared similar features between patients aged 18 -40 years and whom aged 41 -45 years. But in patients aged between 41 and 45 years,the ratio of MI in male group was higher than that in female group（50.00% vs 0. 00% ,P 〈0.05） ,and LVEDD in male group was bigger than that in fe- male groupl （51.56±5.05）ram vs （46.14±4.30） mm,P 〈0.051. （4） Coronary angiogram showed most coronary artery disease were single-vessel morbid change, especially left anterior descending branch （ 50.00% ） was more likely to be involved. （5） All of the 24 patients achieved clinical remission after percutaneous transluminal coronary intervention（PCI）. No major adverse cardiac events were observed during their hospitalization and 2 years follow-up. （6） Three patients underwent the screening of rheumatic diseases during the follow-up ,2 patients of them were diagnosed as systemic vasculitis keeping re- mission in the following 2 years. Conclusion Patients with NA-CAD were not rare in clinic, and most of it had development at the age of 40 years old. The ratio of female was higher compared with that in traditional atherosclerotic CAD patients ;in female patients, the onsets were relatively occult and the manifestations were not serious;single-vessel involvement was more likely to be found ; given the PCI of NA-CAD, the short-term outcome was good. It is suggested that systemic vasculitis may be one of the causes of NA-CAD. For young female with suspected CAD, exclude non-atheroselerotie diseases such as vasculitis should be recommended.