Miwa K, Fujita M, Ejiri M, Sasayama S
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
Am Heart J. 1990 Sep;120(3):544-50. doi: 10.1016/0002-8703(90)90008-l.
To elucidate the possible contribution of coronary artery spasm to the pathogenesis of angina pectoris, coronary arterial responses to intracoronary injection of acetylcholine were examined in patients with various types of angina pectoris. Coronary artery spasm with chest pain and/or electrocardiographic ischemic changes was angiographically demonstrated in 50 (85%) of 59 patients with angina pectoris. The sensitivity for coronary spasm was 92% (24 of 26) in patients with rest angina, 100% (16 of 16) in patients with both rest and effort angina, and 59% (10 of 17) in patients with effort angina, while it was only 6% (1 of 16) in patients without coronary artery disease. When patients with effort angina were subdivided according to the variability of anginal threshold for exertional angina, the sensitivity for coronary spasm was as high as 90% (9 out of 10) in patients with variable-threshold angina. In contrast, coronary spasm was less frequently (p less than 0.05) induced in patients with fixed-threshold angina (1 of 7, 14%). These results suggest that coronary arteries in patients with angina pectoris are quite susceptible to acetylcholine except in those patients with stable exercise tolerance or anginal threshold. Thus coronary artery spasm appears to play a significant role for the pathogenesis of angina pectoris in a large proportion of patients with effort angina as well as in patients with rest angina.
为阐明冠状动脉痉挛在心绞痛发病机制中的可能作用，对各类心绞痛患者进行了冠状动脉内注射乙酰胆碱后的动脉反应检查。59例心绞痛患者中，50例（85%）经血管造影证实存在伴有胸痛和/或心电图缺血改变的冠状动脉痉挛。静息型心绞痛患者对冠状动脉痉挛的敏感性为92%（26例中的24例），静息型与劳力型心绞痛患者为100%（16例中的16例），劳力型心绞痛患者为59%（17例中的10例），而无冠状动脉疾病的患者仅为6%（16例中的1例）。根据劳力型心绞痛心绞痛阈值的变异性对劳力型心绞痛患者进行细分时，阈值可变型心绞痛患者对冠状动脉痉挛的敏感性高达90%（10例中的9例）。相比之下，阈值固定型心绞痛患者诱发冠状动脉痉挛的频率较低（p<0.05）（7例中的1例，14%）。这些结果表明，除运动耐量稳定或心绞痛阈值固定的患者外，心绞痛患者的冠状动脉对乙酰胆碱非常敏感。因此，冠状动脉痉挛似乎在很大一部分劳力型心绞痛患者以及静息型心绞痛患者的心绞痛发病机制中起重要作用。
