Okumura K, Yasue H, Matsuyama K, Ogawa H, Kugiyama K, Ishizaka H, Sumida H, Fujii H, Matsunaga T, Tsunoda R
Division of Cardiology, Kumamoto University School of Medicine, Japan.
J Am Coll Cardiol. 1996 Jan;27(1):45-52. doi: 10.1016/0735-1097(95)00432-7.
We examined the vasomotility of the entire epicardial coronary artery system in patients with and without coronary spastic angina.
The coronary arteries of patients with variant angina are hyperreactive to diverse constrictor stimuli. It is unclear whether the abnormal responses to constrictive or dilative stimuli, or both, result from a localized or diffuse disorder in the coronary artery tree.
Coronary artery diameter responses to intracoronary acetylcholine and nitroglycerin were examined at the proximal, middle and distal segments of three principal coronary arteries in 36 patients with coronary spastic angina without significant stenosis and in 12 young (< or = 30 years old) and 20 older control subjects (> 30 years old) with normal coronary arteriographic findings. In 10 patients with significant coronary stenosis, the responses of the prestenotic segments were also examined.
In patients with coronary spastic angina, coronary spasm was induced in 23 left anterior descending, 13 left circumflex and 17 right coronary arteries by acetylcholine. Multivessel spasm was observed in 15 patients. Acetylcholine had a dilator effect on most segments in young control subjects and a mild constrictor effect in older control subjects and in patients with significant stenosis. Comparison of the responses to acetylcholine among groups demonstrated that the constrictor response of the artery with spasm was enhanced significantly and diffusely. That of the artery without spasm also tended to be enhanced. Coronary artery diameters after nitroglycerin did not differ in any segment among patients with coronary spastic angina and both control groups. In patients with coronary spastic angina, nitroglycerin significantly enhanced dilation in all segments of the artery with spasm compared with that observed in both control groups and in most segments of the artery without spasm. Patients with significant coronary stenosis had a reduced response compared with that in control subjects.
Hyperreactive responses not only to the constrictor effects of acetylcholine, but also the dilator effects of nitroglycerin were detected diffusely in the epicardial coronary arteries of patients with coronary spastic angina. This finding indicates that a diffuse, not localized, disorder in vasomotility is involved in the pathogenesis of coronary spastic angina.
我们研究了有和没有冠状动脉痉挛性心绞痛患者的整个心外膜冠状动脉系统的血管运动功能。
变异型心绞痛患者的冠状动脉对多种收缩刺激反应过度。目前尚不清楚对收缩或扩张刺激的异常反应，或两者兼而有之，是由冠状动脉树中的局部还是弥漫性疾病引起的。
在36例无明显狭窄的冠状动脉痉挛性心绞痛患者、12名年轻（≤30岁）和20名年长（>30岁）冠状动脉造影结果正常的对照受试者的三支主要冠状动脉的近端、中段和远端节段，检测冠状动脉内径对冠状动脉内注射乙酰胆碱和硝酸甘油的反应。对10例有明显冠状动脉狭窄的患者，也检测了狭窄前节段的反应。
在冠状动脉痉挛性心绞痛患者中，乙酰胆碱诱发了23支左前降支、13支左旋支和17支右冠状动脉痉挛。15例患者观察到多支血管痉挛。乙酰胆碱对年轻对照受试者的大多数节段有扩张作用，对年长对照受试者和有明显狭窄的患者有轻度收缩作用。各组间乙酰胆碱反应的比较表明，痉挛动脉的收缩反应显著增强且呈弥漫性。无痉挛动脉的收缩反应也有增强趋势。冠状动脉痉挛性心绞痛患者和两个对照组的任何节段硝酸甘油后的冠状动脉内径均无差异。在冠状动脉痉挛性心绞痛患者中，与两个对照组和无痉挛动脉的大多数节段相比，硝酸甘油显著增强了痉挛动脉所有节段的扩张。与对照受试者相比，有明显冠状动脉狭窄的患者反应减弱。
在冠状动脉痉挛性心绞痛患者的心外膜冠状动脉中，不仅检测到对乙酰胆碱收缩作用的反应过度，而且对硝酸甘油扩张作用的反应也呈弥漫性过度。这一发现表明，血管运动功能的弥漫性而非局部性紊乱参与了冠状动脉痉挛性心绞痛的发病机制。
