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10%到30%的胸痛患者并无明显的冠状动脉病变(coronary artery disease,CAD),但50%到65%患者的细小冠状动脉血管舒张功能受损,发生冠状动脉微循环障碍(coronary microvascular dysfunction,CMD),即微血管型心绞痛(microvascular angina,MA),目前尚无针对MA的最佳治疗方案。本文综述了既往7篇微血管型心绞痛的治疗方案的临床研究结果,提示西地那非,喹那普利,雌激素和经皮脊髓电刺激对本病有一定的治疗效果,但并未发现L-精氨酸,多沙唑嗪,普伐他丁和地尔硫卓对本病有明确疗效。然而,这7篇研究对冠状动脉微循环障碍的定义不同、采用的治疗方案和效果评价指标存在较大差异,纳入的样本量较小,这些都严重影响了临床研究结果的可靠性。在将来的相关临床试验中需统一冠脉微循环障碍的定义,评估无阻塞性冠脉病变所致胸痛的冠脉微循环障碍以及相应的治疗效果。
In 10% to 30% of patients with chest pain, there is no significant coronary artery disease (CAD), but coronary microcirculatory dysfunction occurs in 50% to 65% of patients with impaired coronary vasodilation , CMD), namely microvascular angina (MA), there is no optimal treatment for MA. This review summarizes the results of previous clinical studies on the treatment of angina pectoris in seven patients, suggesting that sildenafil, quinapril, estrogen and transcutaneous electrical stimulation of spinal cord have some therapeutic effect, but did not find that L - Arginine, doxazosin, pravastatin and diltiazem have a clear effect on the disease. However, these seven studies differed in their definition of microcirculation impairment in the coronary arteries. There was a large discrepancy between the treatment regimen and the effect evaluation index, and the small sample size involved, which seriously affected the reliability of the clinical research results. In the future related clinical trials need to unify the definition of coronary microcirculation, assessment of non-obstructive coronary artery disease caused by chest microcirculation and chest pain and the corresponding treatment.