Quyyumi A A, Al-Rufaie H K, Olsen E G, Fox K M
Br Heart J. 1985 Oct;54(4):362-6. doi: 10.1136/hrt.54.4.362.
The histology of coronary arteries was compared in patients with rest and effort angina. The arteries came from six patients with three vessel disease who died within four weeks of arteriography and ambulatory ST segment monitoring. Sections of all macroscopically visible arteries were taken every 5 mm and examined histologically. Episodes of ST segment depression had occurred on exertion in two patients, during exertion and rest (nocturnal) in two, and two patients had had no episodes of ST segment depression during ambulatory monitoring. Concentric (29%) or eccentric (62%) intimal thickening due to atheroma or fibroelastic tissue was found in 91% of sections. All but two normal intimal sections (1%) were found to be diseased in patients with ambulatory ST segment changes. Eccentric lesions with medial smooth muscle preservation in areas without intimal thickening, where further luminal narrowing could occur due to increases in smooth muscle tone, were found in 15% of sections. But these areas were not found in the proximal 3.5 cm of any of the major coronary arteries of the two patients with rest and effort ischaemia. Spasm could not have caused total occlusion in any of these arteries because the lumen was splinted by the lesion. There was no difference in mean luminal narrowing between patients with exertional and rest ischaemia and exertional ischaemia only (mean 74%), but mean luminal narrowing was lower in patients with no ambulatory episodes of ST segment change (39%). Thus medial smooth muscle spasm was unlikely to have caused occlusion in patients with ambulatory ST segment changes, although it could have altered lumen diameter. There are no histological differences in the coronary arteries of patients with rest or effort induced myocardial ischaemia.
对静息型心绞痛和劳力型心绞痛患者的冠状动脉组织学进行了比较。这些动脉取自6例患有三支血管病变的患者，他们在进行动脉造影和动态ST段监测后的四周内死亡。每隔5毫米取所有肉眼可见动脉的切片，并进行组织学检查。2例患者在运动时出现ST段压低，2例在运动和静息（夜间）时出现，2例在动态监测期间未出现ST段压低。91%的切片发现由于动脉粥样硬化或纤维弹性组织导致的同心性（29%）或偏心性（62%）内膜增厚。除了两片正常内膜切片（1%）外，所有动态ST段有变化的患者的内膜切片均发现病变。15%的切片发现偏心性病变，在没有内膜增厚的区域保留了中层平滑肌，由于平滑肌张力增加，此处可能会进一步出现管腔狭窄。但在两名患有静息和劳力性缺血的患者的任何主要冠状动脉近端3.5厘米处均未发现这些区域。痉挛不可能导致这些动脉中的任何一条完全闭塞，因为管腔被病变固定。劳力性缺血和静息性缺血患者与仅劳力性缺血患者之间的平均管腔狭窄没有差异（平均74%），但动态ST段无变化的患者平均管腔狭窄程度较低（39%）。因此，虽然内侧平滑肌痉挛可能改变管腔直径，但不太可能导致动态ST段有变化的患者发生闭塞。静息或劳力诱发心肌缺血患者的冠状动脉在组织学上没有差异。
