微血管心绞痛患者心肌微循环血流动力学的探索

Exploration of Myocardial Microcirculation Hemodynamics in Patients with Microvascular Angina Pectoris

目的探索原发性微血管心绞痛患者心肌微循环血流动力学及血管活性物质的变化。方法选择2017年12月至2018年12月阜外华中心血管病医院22例原发性微血管心绞痛住院患者为试验组,无心绞痛症状冠状动脉造影正常的18例住院患者为对照组,比较两组患者心肌微循环血管灌注压力、阻力及局部血管活性物质的变化。结果试验组冠状动脉口处的收缩压、舒张压、平均动脉压及脉压指数均高于对照组,差异有统计学意义(P<0.05)。试验组造影剂从冠状动脉起始至血管远端显影所需的帧数、冠状窦充盈时间、微循环阻力指数均高于对照组,血浆内皮素-1(ET-1)水平高于对照组,一氧化氮水平(NO)低于对照组,差异有统计学意义(P<0.05)。结论原发性微血管心绞痛患者推动血流循环的动力并未降低,血液通过心肌微循环的速度减慢,微循环阻力增高,与局部心肌循环中的ET-1、NO水平变化相关。

Objective To explore the changes of myocardial microcirculation hemodynamics and vasoactive substances in patients with primary microvascular angina pectoris.Methods From December 2017 to December 2018,22 inpatients with primary microvascular angina pectoris in Central China Fuwai Hospital were selected as the experimental group,and 18 inpatients without angina pectoris with normal coronary angiography were selected as the control group.The changes of myocardial microcirculation vascular perfusion pressure,resistance and local vasoactive substances were compared between the two groups.Results The systolic pressure,diastolic pressure,mean arterial pressure and pulse pressure index at the coronary artery origin in the experimental group were higher than those in the control group,with statistically significant differences(P<0.05).The frames required for contrast agent from the origin of the coronary artery to the distal vessels,coronary sinus filling time and microcirculation resistance index in the experimental group were higher than those in the control group,the plasma endothelin-1(ET-1)level was higher than that in the control group,and the level of nitric oxide(NO)was lower than that in the control group,with statistically significant differences(P<0.05).Conclusion The driving force of blood circulation in patients with primary microvascular angina pectoris is not decreased,the blood flow through myocardial microcirculation is slowed down,and the microcirculation resistance is increased,which is related to the changes of ET-1 and NO levels in local myocardial circulation.