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目的:报道合并阻塞性冠状动脉疾病的冠状动脉微血管疾病（coronary microvascular disease, CMVD) 1例，并回顾文献总结诊治经验。病例介绍:患者男性，55岁，因“发作性胸骨后疼痛3个月余，加重10 d”于2019年6月28日入住山东大学齐鲁医院心内科。确诊为“冠心病，不稳定型心绞痛，心功能纽约心脏病协会分级Ⅰ级，高血压病（2级，很高危）”。经冠状动脉造影证实，患者左前降支开口处重度狭窄（狭窄90%），其他心外膜冠状动脉多处轻度狭窄，于左前降支（left anterior descending branch, LAD）开口至近段行经皮冠状动脉介入治疗（percutaneous transluminal coronary intervention, PCI）解除重度狭窄。PCI术后患者仍反复出现胸痛，经胸多普勒超声心动图冠状动脉血流储备（coronary flow reserve, CFR）检查显示左前降支最大血流速度CFR为1.87，结合CT心肌灌注显像结果，除左心室下壁基底段及中间段外，其余左心室室壁心肌灌注弥漫性减低，提示患者合并CMVD。在不稳定型心绞痛治疗方案中联合改善冠状动脉微循环药物治疗后，患者胸痛症状明显缓解，8周后复查CFR较前明显改善。文献检索及分析:检索PubMed数据库，关键词包括“coronary microvascular disease” “coronary artery obstructive disease”和“case report” 。截至2021年11月22日，共检出文献35篇，其中合并冠状动脉非阻塞病变的CMVD病例报道24篇，包括女性心绞痛患者病例、冠状动脉非阻塞病变致心肌梗死（myocardial infarction with non-obstructive coronary arteries，MINOCA）病例，以及CMVD所致心力衰竭病例，未检索合并冠状动脉阻塞病变的CMVD病例报道，其他类型的CMVD病例报道11篇。对于CMVD的治疗目前尚未有一致定论，多是基于改善患者症状的抗心肌缺血药物、改善患者心血管事件预后的血管紧张素转化酶抑制剂（angiotensin converting enzyme inhibitor, ACEI）/血管紧张素受体阻滞剂（angiotensin receptor blockers, ARB）等，以及针对心血管危险因素的干预策略，尚无以心血管事件为结局的CMVD大样本临床研究。结论:对于合并阻塞性冠状动脉疾病的CMVD患者的诊断，应循序渐进，如抽丝剥茧，细致评估包括心外膜冠状动脉和冠状动脉微循环在内的全冠状动脉结构和功能，指导个体化和精准性诊疗。“,”Objective:To report a case of coronary microvascular disease (CMVD) with obstructive coronary artery disease and to summarize the experience of diagnosis and treatment in the context of a literature review.Clinical Feature:A 55-year-old male was diagnosed with coronary atherosclerotic heart disease, unstable angina, cardiac function level Ⅰ (NYHA class), and hypertension (grade 2, very high risk) for the chief complaint of “paroxysmal post-sternal pain lasted for more than three months and aggravated for 10 days.” He was admitted to the Department of Cardiology, Qilu Hospital, Shandong University on June 28, 2019. Coronary angiography confirmed severe stenosis (stenosis 90%) at the opening of the left anterior descending branch (LAD) with multiple mild stenosis of other coronary vessels. Percutaneous transluminal coronary intervention (PCI) was performed on the LAD opening to the proximal segment. The patient with recurrent chest pain after PCI underwent an examination of the coronary flow reserve (CFR) by transthoracic Doppler echocardiography. It showed that the CFR base on the maximum blood flow velocity of the LAD was 1.87. Computed tomography myocardial perfusion imaging reports showed that the myocardial perfusion of the left ventricle was diffusely decreased, except for the basal and middle segments of the posterior wall of the left ventricle, suggesting that the patient was complicated with CMVD. After drugs were administered to improve coronary microcirculation as part of the unstable angina treatment regimen, the patient\'s chest pain symptoms were significantly relieved, and the CFR was significantly improved after eight weeks.Data Review:PubMed was searched with the keywords, “coronary microvascular disease, coronary artery obstructive disease, and case report” . Up to November 22, 2021, a total of 35 studies have been reported, including 24 cases of CMVD with non-obstructive coronary artery disease, zero cases with obstructive coronary artery disease, and 11 cases of other types CMVD. Twenty-four publications of CMVD with non-obstructive coronary artery diseases were reported, including female patient cases with angina pectoris, cases of myocardial infarction with non-obstructive coronary artery diseases, and heart failure cases secondary to CMVD. Currently, there is no consensus on the treatment of CMVD. The treatment is mostly based on anti-myocardial ischemia drugs that improve the symptoms of patients. Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and other intervention strategies targeting cardiovascular risk factors have also been used. No large-sample clinical studies of CMVD aimed at cardiovascular outcomes have been conducted.Conclusions:The diagnosis of CMVD patients with obstructive coronary artery disease should be performed in a step-by-step manner. The structure and function of the whole coronary artery, including epicardial coronary and coronary microcirculation, should be carefully evaluated to guide the clinician for a precise diagnosis and treatment.