变异型心绞痛与冠状动脉病变关系临床分析

Clinical analysis of relationship between VA and Coronary disease

目的 :探讨变异型心绞痛与冠状动脉病变的关系。方法 :临床观察 88例VA患者 ,均采用标准 18导联心电图或CM5/CMavF导联系统进行Holter监测 2 4小时 ,并行冠状动脉造影检查 ,明确VA发作时ST段抬高导联的分布特点、与冠状动脉病变的有无、病变范围及程度的关系。结果 :88例患者经冠状动脉造影显示 :冠状动脉狭窄 <5 0 %者占 3 9 8% ,冠状动脉狭窄在 5 0 %～ 10 0 %者占 61 2 %。而冠状动脉造影正常的VA患者发作时痉挛部位在右冠状动脉 (RCA)的占 82 9% ,与在左前降支 (LAD)的占 11 4% ,在左回旋支 (LCX)的占 5 7%比 (P <0 0 0 1) ;存在冠状动脉固定性狭窄的VA患者发作时痉挛部位在LAD的占5 4 7% ,与痉挛部位在RCA的占 2 2 6% ,在LCX的占 2 2 6%比 (P <0 0 1)。结论 :在冠状动脉无明显病变的VA患者中 ,RCA痉挛的发生率明显高于LAD ;而对于存在冠状动脉固定性狭窄的VA患者 ,冠状动脉痉挛的发生率以LAD最高。

Objective:To access the relationship between variant angina(VA)and coronary disease. Methods:It is a retrospective study of 88 patients with VA,who had undergone coronary angiograph(CAG)and holter 18-lead electrocardiogram.Results: Among patients whose GAG results were normal,when variant angina attacked,the incidence of spasm on RCA,LAD and LCX was 82.9%,11.4% and 5.7%,respectively(P<0.001).Among patients whose CAG showed stenosis in their coronary artery,when VA attacked,the incidence of spasm on LAD was 54.7%,on RCA and LCX was both 22.6%(P<0.01).Conclusion:The incidence of spasm on RCA was evidently higher than that on LAD among patients whose CAG results were normal.Among patients with stenosis in their coronary artery,the incidence of spame on LAD is the highest.