吸烟和高脂血症是冠状动脉痉挛的重要危险因子

目的：探讨临床上具有心绞痛样胸痛发作但无显著冠状动脉狭窄患者胸痛的病因，并甄别与冠状动脉痉挛相关的临床危险因子，方法：对275例临床上具有心绞痛发作但冠状动脉造影无显著冠状动脉狭窄患者进行乙酰胆碱试验，以冠状动脉狭窄程度达到90％以上伴胸痛发作和／或心电图缺血性改变为冠状动脉痉挛的诊断标准。Logistic回归强迫引入法分析冠状动脉痉挛与性别，年龄，高血压，糖尿病，吸烟，血脂代谢紊乱和心电图活动平板试验结果的关系，并根据乙酰胆碱试验结果分组比较左室射血分数和舒张末期压力，结果：271例资料完整的患者中乙酰胆碱试验的阳性率为38％，Logistic回归分析表明，吸烟和高脂血症分别使冠状动脉痉挛的优势比（OR）值增加4．2倍和2．3倍，糖尿病与冠状动脉痉挛呈显著负相关，冠状动脉痉挛对左室功能无明显影响，结论：冠状动脉痉挛是冠状动脉造影正常的心绞痛患者的重要病因之一，吸烟和高脂血症是冠状动脉痉挛的重要危险因子。

Smoking and hyperlipidemia are the important risk factors of coronary artery spasm

Objective To investigate the etiology of chest pain in patients who have anginoid chest pain but without significant coronary stenosis and to differentiate the clinical risk factors related to coronary spasm. Methods 275 patients with chest pain but without significant coronary artery stenosis by coronary angiography were included to undertake intracoronary acetylcholine test. Coronary artery spasm was diagnosed when coronary artery stenosis increased to 90% and accompanied by usual chest pain and/or ischemic changes on electrocardiogram. Logistic regression was employed to analyze the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking, hyperlipidemia and results of electrocardiographic treadmill stress test. Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group based on results of acetylcholine test. Results Coronary artery spasm was detected in 103 out of 271 patients, with a positive rate of 38%. Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm by 4.2 times and 2.3 times respectively. There was a significantly negative correlation between diabetes mellitus and coronary artery spasm. Coronary artery spasm had no effect on left ventricular ejection fraction. Conclusions Coronary artery spasm is one of the important etiologies for patients with chest pain but without coronary artery stenosis. Smoking and hyperlipidemia are the important risk factors of coronary artery spasm.