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心绞痛是心肌缺血最常见的临床症状,在全世界范围内,心绞痛患者多达1亿余人。因心肌缺血接受冠状动脉造影(coronary angiography, CAG)的患者中,约70%无阻塞性冠状动脉疾病,这其中很大一部分属于缺血伴非阻塞性冠状动脉疾病(ischaemia with non-obstructive coronary arteries,INOCA)[1]。INOCA的女性发病率约为47%(34%~65%),男性约为30%(14%~36%)[2-3]。本文对INOCA的影像学诊断现状及研究进展进行综述,重点介绍INOCA的临床现状与INOCA相关的有创、无创影像学诊断方法及意义。
缺血伴非阻塞性冠状动脉疾病的影像学诊断现状及研究进展
Current status and research progress in the imaging diagnosis of ischaemia with non-obstructive coronary arteries
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摘要: 缺血伴非阻塞性冠状动脉疾病(INOCA)的发病率较高,患者的胸痛症状多不典型且表现多样,同时其分型较多,因此极易被患者自身和临床医师所忽视。随着临床对INOCA的致病原因和不良预后认识的不断加深,近年来用于INOCA诊断的无创或有创方法的研究和应用进展快速。INOCA的致病原因包括心外膜冠状动脉痉挛(CAS)和微血管功能障碍(CMD)。因此,各种诊断方法基本围绕CAS和CMD进行。通过诊断并分析其致病原因,最终实现对INOCA患者的针对性治疗,改善患者的症状、生活质量和预后。笔者主要对INOCA的诊断现状和研究进展进行综述,以提高临床医师对INOCA的认识、深入了解INOCA相关的影像学诊断手段。
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关键词:
- 冠状血管 /
- 缺血伴非阻塞性冠状动脉疾病 /
- 心外膜冠状动脉痉挛 /
- 微血管功能障碍 /
- 影像诊断
Abstract: Ischaemia with non-obstructive coronaries arteries(INOCA) has a high morbidity. The atypical and diverse presentation of patients with chest pain, and its multiple endotypes have led to a high risk of being overlooked by patients themselves and clinicians. The pathogenesis of INOCA includes epicardial coronary artery spasm (CAS) and coronary microvascular dysfunction (CMD). Therefore, various diagnostic methods basically revolve around CAS and CMD. By diagnosing and analyzing its pathogenetic factors, the authors can ultimately achieve targeted treatment for patients with INOCA and improve their symptoms, quality of life and prognosis. This paper reviews the current status and research progress of diagnoses for INOCA to improve the clinician's knowledge of INOCA and in-depth understanding of INOCA related imaging diagnostic means. -
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