Husser Daniela, Bollmann Andreas, Kühne Christian, Molling Jochen, Klein Helmut U
Department of Cardiology, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
Eur J Pain. 2006 Jan;10(1):51-5. doi: 10.1016/j.ejpain.2005.01.011.
Approximately 30% of coronary angiograms are negative for significant coronary artery disease and patients are classified as having noncardiac chest pain (NCCP). So far, no systematic diagnostic approach to patients with NCCP investigating for possible esophageal, psychiatric and musculoskeletal abnormalities exists. Furthermore, coping strategies and quality of life are poorly characterized in NCCP patients.
A simple diagnostic approach was applied to 37 consecutive patients (21 female, age 61+/-12 years) with angina-like chest pain and normal coronary angiograms. Twenty-one patients were found to suffer from psychiatric disorders (combined anxiety (A) and depression (D): n = 10, D: n = 5, panic disorder (P): n = 3, somatization (S): n = 3) based on their Symptom Check List 90 scores and according to DSM IV-R criteria. Sixteen patients had an improvement of their chest pain after oral esomeprazole (40 mg for 7 days) and were therefore diagnosed with gastroesophageal reflux disease (GERD). Musculoskeletal abnormalities including chostochondritis (n = 4), thoracic spondylodynia (n = 1), and fibromyalgia (n = 1) were found in six patients. Multiple diagnoses were confirmed in six patients with GERD (additional D n = 3, additional musculoskeletal disorders n = 3). Patients with psychiatric disorders showed a diminished quality of life (MOS-SF 36), more frequent chest pain, less treatment satisfaction (Seattle Angina Questionnaire) and more rumination (Trier Coping Scales) compared to GERD patients.
Immediate combined psychiatric and orthopedic evaluation as well as esomeprazole administration following exclusion of coronary artery disease may confirm the causes of noncardiac chest pain. Identification of psychiatric disorders seems especially warranted since these patients experience a reduced quality of life and exhibit pathologic coping strategies.
约30%的冠状动脉造影显示无明显冠状动脉疾病，这些患者被归类为患有非心源性胸痛（NCCP）。到目前为止，尚无针对NCCP患者调查可能的食管、精神和肌肉骨骼异常的系统诊断方法。此外，NCCP患者的应对策略和生活质量特征尚不明确。
对37例连续的有类似心绞痛胸痛且冠状动脉造影正常的患者（21例女性，年龄61±12岁）应用了一种简单的诊断方法。根据症状自评量表90得分并按照DSM-IV-R标准，发现21例患者患有精神障碍（合并焦虑（A）和抑郁（D）：n = 10，D：n = 5，惊恐障碍（P）：n = 3，躯体化（S）：n = 3）。16例患者口服埃索美拉唑（40mg，共7天）后胸痛改善，因此被诊断为胃食管反流病（GERD）。6例患者发现有肌肉骨骼异常，包括肋软骨炎（n = 4）、胸椎疼痛（n = 1）和纤维肌痛（n = 1）。6例GERD患者确诊有多种诊断（额外的D：n = 3，额外的肌肉骨骼疾病：n = 3）。与GERD患者相比，患有精神障碍的患者生活质量（MOS-SF 36）降低，胸痛更频繁，治疗满意度更低（西雅图心绞痛问卷），且反刍更多（特里尔应对量表）。
在排除冠状动脉疾病后立即进行精神科和骨科联合评估以及给予埃索美拉唑可能会明确非心源性胸痛的病因。鉴于这些患者生活质量降低且表现出病理性应对策略，似乎尤其有必要识别精神障碍。
