【作者】 姚吉芳；

【导师】 鹿育萨；

【作者基本信息】 山西医科大学 ， 心血管内科， 2004， 硕士

【摘要】 目的：对29例平板运动试验阳性或可疑阳性而冠状动脉造影正常的胸痛待诊病人的临床特征进行回顾性分析，为胸痛的临床诊断提供思路。方法：用回顾性病历分析方法，选择29例平板运动试验阳性或可疑阳性、冠状动脉造影结果正常的胸痛待诊病人，对其临床症状及辅助检查结果进行分析。结果：29例平板运动试验阳性或可疑阳性而冠状动脉造影结果正常的胸痛待诊病人中，男14例，女15例，年龄37~65（49.82 ±3.56）岁。临床特征：①不典型心绞痛症状患者16例（55.17％），典型心绞痛症状患者13例（44.8％）；②存在高血压者4例（13.79％）；③心律失常6例（20.69%）；④糖耐量异常3例（10.34%）；⑤血脂异常者16例（55.17％）其中甘油三酯增高居多14例（48.27％）；⑥未发现心血管危险因素者9例（31.03％）；辅助检查结果改变：平板运动试验阳性22例，可疑阳性7例；静息心电图ST-T段改变20例，正常9例；同位素心肌灌注显像心肌缺血1例；超声心动图正常22例；X线胸片检查正常29例。结论：①以不典型心绞痛为主要症状，不伴或极少冠心病危险因素，平板运动试验阳性或可疑阳性的患者，临床诊断为冠心病应慎重，最好通过冠状动脉造影检查明确诊断。②以典型心绞痛为主要症状，平板运动试验阳性或可疑阳性而冠状动脉造影正常的患者，其发病机制尚未完全阐明，考虑与冠状微血管异常及冠脉重构有关。更多还原

【Abstract】 Objective:To analyze the clinical features of patients with chest pain and abnormal treadmill exercise test but normal coronary angiography.Methods:The clinical datas of 29 patients with chest pain and abnormal treadmill exercise test but normal coronary angiography were analyzed retrospectively. Results:In 29 cases patients with chest pain and abnormal treadmill exercise test but normal coronary angiography:the total group including 14 males and15 females,age ranged from 37 to 65(49.82 ±3.56) years;①most of patients had atypical chest Pain in16 cases(55.17％),patients had typical chest Pain in 13 cases(44.13％);②hypertension existed in 4 cases (13.79%);③cardiac arrhythmia existed in 6 cases(20.7%);④IGT existed in 3 cases(10.34%);⑤case of high plasma TC level(14 cases, 48.27％) were predominant in abnormal plasma lipid level(16 cases,55.17%).⑥there were 9 cases(31.03%) without risky factor.⑦results of treadmill exercise test were positive in 22 patients and doubtful positive in 7 patients;there were 20 cases whose ST-T of rest status ECG changed and 9 cases whose rest status ECG was normal;there was 1 case demonstrated myocardial ischemic by myocardial perfusion imaging; echocardiography were normal in 22 cases;X-ray test were normal in 29 cases. Conclusion:To these who have seldomly cardiac vascular risk factors and have untypical symptom of angina pectoris,the diagnosis of CHD should be maden cautiously even though they have abnormal treadmill exercise test.It is suggested that coronary angiography should be considered for these pectoris.To these who have typical symptom of angina pectoris and abnormal treadmill exercise test but normal coronary angiography,the mechanisms of the disease was unclear.Microvascular angina and coronary arteries remodeling are relational.更多还原