2024 年第 5 期 第 0 卷

微血管心绞痛患者心肌局部氧和物质代谢变化的观察研究

Local myocardial changes in oxygen and nutrient metabolism in patients with microvascular angina

作者：于运福 陈小贞 闫瑞 孙涛 闫继锋

英文作者：Yu Yunfu Chen Xiaozhen Yan Rui Sun Tao Yan Jifeng

单位：阜外华中心血管病医院河南省人民医院心脏中心心血管内科，郑州450003

英文单位：Department of Cardiovascular Medicine Heart Center Fuwai Central China Vascular Hospital Henan Provincial People′s Hospital Zhengzhou 450003 China

关键词：微血管心绞痛；心肌微循环；物质代谢；内环境

英文关键词：Microvascularangina;Myocardialmicrocirculation;Metabolicmetabolism;Internalenvironment

• 摘要：

• 目的  探讨微血管心绞痛患者心肌局部氧和物质代谢的变化。方法  选取阜外华中心血管病医院2020年1月至2022年6月收治的原发性微血管心绞痛患者22例为观察组，另选取同期因阵发性室上性心动过速行射频消融治疗而无临床心绞痛症状者18例为对照组。观察2组患者心肌微循环前后局部氧、物质代谢、内环境及心肌微血管功能的变化。结果  观察组冠状动脉口血pH值、血糖水平均低于对照组，乳酸、氧分压及氧饱和度均高于对照组（均P＜0.05）；冠状窦口血pH值、乳酸、血糖、氧饱和度水平均低于对照组，二氧化碳分压高于对照组（均P＜0.05）。观察组葡萄糖摄取率、乳酸生成率、校正心肌梗死溶栓试验帧数（TCFC）、冠状静脉窦充盈时间（CSFT）、微循环阻力指数（IMR）及血浆内皮素1水平均高于对照组，一氧化氮水平低于对照组（均P＜0.05）。Pearson相关性分析结果显示，微血管心绞痛与冠状动脉TCFC（r=0.327，P=0.040）、CSFT（r=0.435，P=0.006）、IMR（r=0.826，P＜0.001）、内皮素1（r=0.517，P=0.001）呈正相关，与一氧化氮（r=-0.504，P＜0.001）呈负相关。此外，IMR与内皮素1（r=0.480，P=0.002）呈正相关，与一氧化氮（r=-0.505，P=0.001）呈负相关。结论  微血管心绞痛患者的整体心肌氧气供应、代谢正常；区域性心肌灌注不足，局部缺氧、内环境酸化，心肌葡萄糖无氧酵解增强，微血管舒缩功能紊乱。

• Objective  To investigate the changes in the local myocardial oxygen and nutrient metabolism in patients with microvascular angina. Methods  A total of 22 patients with primary microvascular angina pectoris admitted to Fuwai Central China Vascular Hospital from January 2020 to June 2022 were selected as the observation group, and 18 patients without clinical symptoms of angina pectoris who underwent radiofrequency ablation due to parsmal supraventricular tachycardia during the same period were selected as the control group. The changes of local oxygen, substance metabolism, internal environment and myocardial microvascular function before and after myocardial microcirculation were observed in the two groups. Results  The pH value and blood glucose level of the ostium of the coronary artery in observation group were lower than those in control group, and the lactic acid, oxygen partial pressure and oxygen saturation were higher than those in control group (all P<0.05). The levels of pH value, lactic acid, blood glucose and oxygen saturation in blood of coronary sinus were lower than those of control group, and the PCO2 was higher than that of control group (all P<0.05). The glucose uptake rate, lactate production rate, frame number of corrected thrombolysis test (TCFC), coronary sinus filling time (CSFT), microcirculation resistance index (IMR) and plasma endothelin-1 level in observation group were higher than those in control group, and the level of nitric oxide was lower than that in control group (all P<0.05). Pearson correlation analysis showed that microvascular angina pectoris was positively correlated with coronary TCFC (r=0.327, P=0.040), CSFT (r=0.435, P=0.006), IMR (r=0.826, P<0.001) and endothelin-1 (r=0.517, P=0.001). There was a negative correlation with nitric oxide (r=-0.504, P<0.001). In addition, IMR was positively correlated with endothelin-1 (r=0.480, P=0.002) and negatively correlated with nitric oxide (r=-0.505, P=0.001). Conclusion  The overall myocardial oxygen supply and metabolism are normal in patients with microvascular angina pectoris. Regional myocardial hypoperfusion, local hypoxia, internal environment acidification, myocardial glucose anaerobic colysis enhancement, microvasomotor dysfunction.