冠状动脉微循环障碍及微血管型心绞痛的治疗现状

Current Therapy for Coronary Microcirculation Dysfunction and Microvascular Angina

10%到30%的胸痛患者并无明显的冠状动脉病变(coronary artery disease,CAD),但50%到65%患者的细小冠状动脉血管舒张功能受损,发生冠状动脉微循环障碍(coronary microvascular dysfunction,CMD),即微血管型心绞痛(microvascular angina,MA),目前尚无针对MA的最佳治疗方案。本文综述了既往7篇微血管型心绞痛的治疗方案的临床研究结果,提示西地那非,喹那普利,雌激素和经皮脊髓电刺激对本病有一定的治疗效果,但并未发现L-精氨酸,多沙唑嗪,普伐他丁和地尔硫卓对本病有明确疗效。然而,这7篇研究对冠状动脉微循环障碍的定义不同、采用的治疗方案和效果评价指标存在较大差异,纳入的样本量较小,这些都严重影响了临床研究结果的可靠性。在将来的相关临床试验中需统一冠脉微循环障碍的定义,评估无阻塞性冠脉病变所致胸痛的冠脉微循环障碍以及相应的治疗效果。

About 10 % to 30 % of chest pain patients are with no significant coronary artery disease （coronary artery disease, CAD）, but 50 % to 65 % of them are with small coronary artery diastolic dysfunction and coronary microcirculation dysfunction （CMD）, namely microvascular angina （microvascular angina, MA）. However, currently there are no optimal treatments for MA. We reviewed the previous 7 clinical trials focusing on the treatment for MA and it was suggested that sildenafil, quinapril, estrogen and transcutaneous electrical nerve stimulation are with therapeutic effect, but The curative effect s of L-arginine, doxazosin, pravastatin and diltiazem were far from conclusive. However these conclusions are far from being generalized because big differences exist in the definition as well as treatment programs for CMD, efficacy evaluation protocols and all these 7 trials are small sample size. In the future clinical trials, the definitions and efficacy evaluation protocols assessment of CMD should be unified to reach a satisfying conclusion.