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目的 探讨分析冠状动脉造影结果阴性的胸痛青年患者(＜ 45岁)的病因,为降低青年人心源性猝死的发病率提供理论依据.方法 选择2014年1月至2014年12月以胸痛来诊,拟诊为急性冠脉综合征(acute coronary syndrome,ACS)而收入解放军总医院的青年患者134例,进行冠状动脉造影,对比分析冠状动脉造影阴性(n=64)、冠状动脉脉造影阳性(n=70)及健康人(n=77)的性别、职业、生化指标[(糖化血红蛋白(HBAlc)、甘油三酯(TG)、,超敏反应蛋白(CRP)、肌钙蛋白T(cTnT)、高密度脂蛋白(HDL)、脑钠利尿肽(BNP)]、心脏功能(室间隔厚度、左室后壁厚度、左室舒张末容积、左室收缩末容积、每搏输出量、射血分数、缩短分数、E值、A值、E/A值),探讨冠状动脉造影阴性患者的病因.统计分析采用Stata 7.0统计软件,计量资料以均数±标准差((x)±s)表示,计数资料以例数和百分比表示,两组间比较采用成组t检验,组间两两比较采用方差分析.结果 冠脉造影阴性患者病因:冠状动脉粥样硬化90.6％、心脏神经官能症4.7％、心肌病1.6％、心脏X综合征1.6％,其他1.5％.冠脉造影阴性患者中公务员管理人员及商业服务人员比例58.9％,男性占81.1％;健康组比较,体质量指数BMI(P=0.000),糖化血红蛋白(HBA1c) (P =0.001),甘油三酯(TG) (P=0.000),超敏C反应蛋白(CRP)(P =0.003),肌钙蛋白T(cTnT) (P=0.009)水平显著性增高,高密度脂蛋白(HDL)(P=0.000)显著性降低,脑钠利尿肽(BNP) (P=0.128)两组间差异无统计学意义;与冠脉造影阳性患者超声心动图比较:左室收缩末容积(P =0.006)显著性降低,左室射血分数(LVEF) (P=0.000)、缩短分数(FS) (P=0.000)显著性升高.结论 冠状动脉粥样硬化是拟诊ACS收入院冠状动脉造影阴性青年胸痛患者的主要病因,男性、高紧张职业、肥胖、高血糖、血脂异常是其高危因素,早期对危险因素进行防控,有利于降低心源性猝死的发病率.“,”Objective To reduce the incidence of sudden cardiac death in young individuals with chest pain suspected to be acute coronary syndrome (ACS) and negative results of angiography,and so explored the causes of it.Methods A total of 134 young patients with suspected ACS admitted in PLA general hospital from January 2014 to December 2014,were checked by coronary angiography.Comparisons of gender,professions,BMI,biochemical variables including glycohemoglobin (HBA1c),triglyceride (TG),C-reactive protein (CRP),troponin T (cTnT),high-density lipoprotein (HDL),brain natriuretic diuresis peptide (BNP)) and cardiac function including interventricular septum thickness,left ventricular posterior wall thickness,left ventricular end-diastolic volume and left ventricular systolic volume,stroke volume,ejection fraction and shortening fraction of left ventricle,E value,A value,E/A value among coronary angiography negative group (n =64),coronary angiography positive group (n =70) and healthy subjects group (n =77).Quantitative variables were presented as means ± standard deviations,categorical data were presented as absolute values and percentages compared using t-test.One-way ANOVA was used to analyze variance between groups.Results The causes of negative group were found to be coronary atherosclerosis (90.6％),cardiac neurosis (4.7％),cardiomyopathy (1.6％),cardiac syndrome X (1.6％),and other 3.2％.There were 81.1％ male and 58.9％ officer of civil service management and business service personnel in negative group.The young patients in negative group had higher levels of BMI (P =0.000),total cholesterol (TC) (P =0.000),hypersensitive C-reactive protein (CRP) (P =0.003),cardiac troponin T (cTnT) (P =0.009) and lower high density lipoprotein (HDL) (P =0.000) compared with healthy subjects group.There was no significant difference in level of brain natriuretic peptide (BNP) between negative group and healthy subjects group (P =0.128).There were higher levels of left ventricular ejection fraction (LVEF) (P =0.000) and fractional shortening (FS) (P =0.000),and lower left ventricular end systolic volume (P =0.006) in negative group compared with positive group.Conclusions Coronary atherosclerosis is the major cause of young patients with chest pain suspected acute coronary syndrome (ACS) and with negative results of coronary angiography.Male,high stress occupation,a sedentary job,obesity,hyperglycemia and dyslipidemia are risk factors.Early diagnosis and prevention strategy are mandatory in these specific young individuals.