不稳定型心绞痛诊断和治疗进展

Advance in Diagnosis and Management of Unstable Angina

近年来有关不稳定型 心绞痛的病理生理诊断及其危险分层与治疗取得很大进展。其发病学为动脉粥样硬化斑块侵蚀或破裂,附壁血栓形成,急剧影响心肌的血供而引起临床症状。基于临床症状,心电图ST-T段改变和心肌细胞损伤的生化标志物的危险分层有助于确立治疗策略和预后判断。抗心肌缺血药降低氧需缓解冠脉痉挛和改善冠脉血流:抗血栓药(包括低分子肝素,糖蛋白Ⅱ b/Ⅲa受体抑制剂)抑制血栓形成。经皮冠脉扩张形术和旁路手术恢复有效血流。尽管现代治疗方面进展较快很多临床试验长期的随访显示仍有较高的临床事件发生。因此仍需寻找新的治疗以使斑块稳定,防止急性冠脉综合征的复发。

In recent years, there have been major advance in the understanding of the pathophysiology,diagnosis,risk stratification and treatment of unstable angina.The pathogenesis is a mural thrombus formation on a ruptured or eroded atherosclerotic plague, Thus,any process that acutely changes the supply-demand ratio (decreased supply and/or increased demand)of myocardial celis can precipitate the clinical presentation of unstable angina.Based on the clinical presentation. ST-T changes in ECG and changes in biochemical makers of myocardial cell in injury.The risk stratification can help to define the therapeutic strategy and prognostic assessment.Anti - ischemic drugs are available to reduce myocardial needs.spasm and improve coronary blood flow,antithrombotic drugs to control thrombus formation.and intervention procedures to restore effective forward flow.Multiple clinical trials have shown high rates of clinical events in the days,weeks and months that follow the acute phase despite the modern therapeutic armamentarium.A new target of treatment is plague passivation to prevent recurrence of the acute coronary syndrome.