Langes K, Volk C, Schneider M A, Koschyk D H, Rinninger F, Nienaber C A
Abteilung für Kardiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Z Kardiol. 1995 Mar;84(3):180-9.
Patients with chest pain and normal epicardial coronary arteries are characterized by an impairment of myocardial perfusion reserve. Functional and morphological abnormalities of the intramyocardial arterioles are suggested to be responsible for this, possibly as a consequence of hypertension and/or left ventricular hypertrophy. In an attempt to isolate predisposing factors of microvascular angina we investigated 34 patients (15 f, 19 m) with a mean age of 53 +/- 7 years. They were diagnosed as microvascular angina without hypertension or left ventricular hypertrophy. Parameters such as plasma insulin, glucose, cholesterol, LDL-cholesterol, triglycerides, (VLDL-cholesterol) and fibrinogen were determined for a metabolic profile. Furthermore, insulin and glucose were measured after an oral glucose load of 100 g glucose (OGTT) over 3 h. All parameters were compared to a control group of 15 healthy people matched for age and body mass index. In the study population systolic blood pressure was within normal limits at 137 +/- 17 mm Hg and thus higher than control at 124 +/- 11 mm Hg (p < 0.02). Furthermore, diastolic blood pressure was 85 +/- 7 mm Hg compared to 78 +/- 9 mm Hg in controls (p < 0.02). Insulin was significantly elevated in patients with microvascular angina 90 min (median: 101 vs 54 microU/ml; p < 0.01) and 120 min (median: 88 vs 51 microU/ml; p < 0.05) after ingestion of 100 g glucose. The fasting glucose was elevated at 98 +/- 12 compared to 87 +/- 7 mg/dl in controls (p < 0.01). Glucose concentration was also elevated after 30 min at 176 +/- 28 compared to 148 +/- 32 mg/dl (p < 0.02), after 45 minutes (198 +/- 35 compared to 152 +/- 53 mg/dl) (p < 0.01) and 60 minutes (193 +/- 44 compared to 145 +/- 54 mg/dl) (p < 0.01). In microvascular angina parameters such as total cholesterol: (244 +/- 46 vs 199 +/- 29 mg/dl (p < 0.01)), LDL-cholesterol (157 +/- 41 vs 122 +/- 18 mg/dl (p < 0.01)) and fibrinogen: (377 +/- 150 vs to 285 +/- 69 mg/dl (p < 0.03)) were elevated. These findings suggest a pathogenetic role of insulin resistance, hyperlipoproteinemia and elevated levels of fibrinogen for impaired myocardial coronary reserve. This metabolic constellation as well as exhaustion of coronary reserve is often found in hypertensive patients and may identify microvascular angina as an early stage of hypertensive heart disease before manifest hypertension has developed.
胸痛且心外膜冠状动脉正常的患者，其特征为心肌灌注储备受损。心肌内小动脉的功能和形态异常被认为是导致这种情况的原因，可能是高血压和/或左心室肥厚的结果。为了找出微血管性心绞痛的易感因素，我们研究了34例患者（15名女性，19名男性），平均年龄为53±7岁。他们被诊断为无微血管性心绞痛，无高血压或左心室肥厚。测定血浆胰岛素、葡萄糖、胆固醇、低密度脂蛋白胆固醇、甘油三酯（极低密度脂蛋白胆固醇）和纤维蛋白原等参数以获取代谢概况。此外，在口服100克葡萄糖（口服葡萄糖耐量试验）3小时后测量胰岛素和葡萄糖。将所有参数与15名年龄和体重指数匹配的健康人组成的对照组进行比较。在研究人群中，收缩压在正常范围内，为137±17毫米汞柱，因此高于对照组的124±11毫米汞柱（p<0.02）。此外，舒张压为85±7毫米汞柱，而对照组为78±9毫米汞柱（p<0.02）。微血管性心绞痛患者在摄入100克葡萄糖后90分钟（中位数：101对54微单位/毫升；p<0.01）和120分钟（中位数：88对51微单位/毫升；p<0.05）时胰岛素显著升高。空腹血糖升高，为98±12，而对照组为87±7毫克/分升（p<0.01）。30分钟后血糖浓度也升高，为176±28，而对照组为148±32毫克/分升（p<0.02），45分钟后（198±35对152±53毫克/分升）（p<0.01）和60分钟后（193±44对145±54毫克/分升）（p<0.01）。在微血管性心绞痛中，总胆固醇（244±46对199±29毫克/分升（p<0.01））、低密度脂蛋白胆固醇（157±41对122±18毫克/分升（p<0.01））和纤维蛋白原（377±150对285±69毫克/分升（p<0.03））等参数升高。这些发现表明胰岛素抵抗、高脂蛋白血症和纤维蛋白原水平升高对心肌冠状动脉储备受损具有致病作用。这种代谢情况以及冠状动脉储备耗竭在高血压患者中经常出现，可能将微血管性心绞痛识别为高血压性心脏病在明显高血压发展之前的早期阶段。
