·冠心病研究·变异性心绞痛的临床特征、诊断评估、处置现状及预后分析尹春琳,魏嘉平,郝恒剑,许冀,徐东,范振兴,夏经纲摘要目的:了解变异性心绞痛(PVA)的临床诊治现状,加深对冠状动脉(冠脉)痉挛导致心肌缺血的认识,为临床及时诊断、避免误诊和漏诊,采取合理治疗提供依据。方法:收集我院2001-01至2011-01临床诊断的PVA患者30例,分析每例患者的临床特征、诊断和临床处置方法及随访结果。结果:本组中年男性多发,吸烟是最主要的危险因素。20例(66.7%)患者PVA发作呈昼夜节律性,13例(43.3%)患者伴有活动时心绞痛发作。PVA可发生心肌梗死、晕厥等严重并发症,通常发生在症状初发后的3~6个月内,远期预后良好。8例患者PVA发作时心电图呈现特征性的巨“R”波或“墓碑”波。PVA累及前降支为41.7%,右冠为45.8%,回旋支为12.5%。本组PVA发生于非显著性狭窄的冠脉和正常冠脉13例(占54.2%)。本组21例患者从PVA初发到确诊的时间在3个月之内,占70%。钙拮抗剂是PVA有效治疗的基石,但不能完全控制血管痉挛,60%以上的病例需要联合治疗。针对狭窄病变的介入治疗不是PVA治疗的有效治疗方法。结论:PVA在临床上的诊断仍然易被忽视,及时诊断是防止致命事件的关键,药物治疗是PVA的首选,对药物治疗失效的患者,介入治疗应在有选择的病例中进行。关键词变异性心绞痛;诊断评估;治疗TheDiagnosisandTreatmentofPatientsWithPrinzmetal’sVariantAnginaYINChun-lin,WEIJia-ping,HAOHeng-jian,XUJi,XUDong,FANZhen-xing,XIAJing-gang.DepartmentofCardiology,XuanwuHospital,CapitalUniversityofMedicalScience,Beijing(100053),ChinaCorrespondingAuthor:YINChun-lin,Email:yinclmail@gmail.comAbstractObjective:Tostudythecurrentclinicalfeatures,diagnosisandtreatmentofPrinzmetal’svariantangina(PVA)inordertobetterunderstandmyocardialischemiacausedbycoronaryarteryspasmandtoimprovethemanagementofpatientswithPVA.Methods:Weretrospectivelyanalyzed30PVApatientswhoweretreatedinourhospitalfromJanuary2001toJanuary2011withtheirclinicalfeatures,diagnosis,treatmentandfollow-upprognosis.Results:PVApatientshadmoremalegenderandsmokinghistory.Therewere20(66.7%)caseshadacircadianrhythmupontheonset,13(43.3%)hadanginapectorisinducedbyphysicalefforts.PVAcouldbecomplicatedwithmyocardialinfarc-tion,syncopeandsuddencardiacdeathwhichusuallyhappenedat3to6monthsaftertheonset.8patientshadthecharacteristicofgiant“R”waveor“tombstone”waveinECG.CoronaryangiographyindicatedthatPVAinvolvedvesselswereleftanteriorde-scendingartery(LAD,41.7%),rightcoronaryartery(RCA,45.8%)andleftcircumflexartery(LCX,12.5%)respectively.PVAusuallyoccurredinnon-significantstenoticcoronaryarteryandnormalcoronaryartery(13cases,54.2%).Itusuallytookabout3monthsfromthefirstattacktocleardiagnosis.CalciumantagonistswerethebasictreatmentforPVA,morethan60%ofpatientsrequiredcombinedmedication.PCIwasnottheeffecfivetreatmentforPVAstenosis.Conclusion:PVAmightbeoverlookedinclinicalpractice,earlydiagnosiswasthekeytopreventfatalevents.MedicationwaspreferredinmostpatientsandPCIcouldbeperformedonlyincertainselectedcases.KeywordsPrinzmetal’svariantangina;Diagnosticassessment;Treatment(ChineseCirculationJournal,2011,26:359.)长期以来,冠状动脉(冠脉)狭窄、斑块破裂和血栓形成一直是被公认的缺血性心脏病心脏事件的重要机制,而冠脉血管痉挛作为缺血性心脏病的另一重要机制和潜在治疗靶点却一直被忽视。冠脉痉挛可以引953中国循环杂志2011年10月第26卷第5期(总第171期)ChineseCirculationJournal,October,2011,Vol.26No.5(SerialNo.171)作者单位:100053北京市,首都医科大学宣武医院心脏科作者简介:尹春琳副主任医师博士硕士研究生导师主要从事心血管疾病的临床诊断、治疗...