变异型心绞痛发病机制及临床特点研究进展

Research progress on pathogenesis and clinical characteristics of variant angina pectoris

变异型心绞痛(VAP)是一种因冠状动脉痉挛所致疾病,临床典型表现主要是胸痛,同时在患者胸痛发作的时候往往伴心电图ST段一过性抬高。VAP的发病机制复杂,包括内皮细胞功能障碍、机体炎性反应及自主神经失衡等,很多的学者认为冠状动脉内皮细胞功能障碍、炎性反应以及自主神经系统失衡为基础病因。如冠状动脉内皮细胞出现损伤的时候,可释放出多种缩血管物质如内皮素、白细胞介素、血清素以及乙酰胆碱等,同时起到血管舒张作用的物质比如一氧化氮以及前列环素等的分泌减少,从而导致VAP的发生。VAP的临床表现除了典型的胸痛,还常伴心律失常甚至猝死情况,此外多数患者也同时存在发热、恶心呕吐与腹痛等症状,严重影响患者的正常生活与工作,因此需要掌握VAP的发病情况,进行尽早诊治,缓解患者症状体征,保证患者生命健康。本文对VAP发病机制、临床特点的相关研究进展做一综述,主要目的是为临床医师制订合理的治疗方案提供参考依据。

Variant angina pectoris(VAP)is a kind of disease caused by coronary artery spasm.The typical clinical manifestation is mainly chest pain.At the same time,patients with chest pain are often accompanied by excessive ST-segment elevation of ECG.The pathogenesis of VAP is complicated,including endothelial cell dysfunction,inflammatory response and autonomic nervous system imbalance,etc.Many scholars believe that coronary endothelial cells dysfunction,inflammatory response and autonomic nervous system imbalance are the basic etiology.For example,when the coronary endothelial cells are injured,a variety of vasoconstrictive substances such as endothelin,interleukin,serotonin and acetylcholine can be released.At the same time,the secretion of vasodilator substances such as nitric oxide and prostacyclin is reduced,which leads to the occurrence of VAP.The clinical manifestations of VAP in addition to the typical chest pain,are often associated with arrhythmia and even sudden death.Most patients also,at the same time,have symptoms such as fever,nausea,vomiting and abdominal pain,seriously affecting the normal life and work.Therefore,it is necessary to master the incidence of VAP,make early diagnosis and treatment,relieve the symptoms and signs of patients,and ensure the life and health of patients.In this paper,the research progress on pathogenesis and clinical characteristics of VAP are reviewed.The main purpose is to provide a reference basis for clinicians to formulate a reasonable treatment plan.