冠状动脉微循环功能障碍的研究进展

Research progress of coronary microcirculation dysfunction

摘要:

缺血性心脏病(IHD)是全球首要致死疾病,尽管冠状动脉介入治疗显著改善了阻塞性冠心病患者预后,但近3/4的心绞痛患者存在缺血伴非阻塞性冠状动脉疾病(INOCA),其中冠状动脉微循环功能障碍(CMD)是INOCA患者心绞痛与心肌缺血的主要机制,约占患者总数的2/3,且女性患病率(56%～82%)显著高于男性。CMD不仅与心力衰竭、心肌梗死、心源性猝死等不良心血管事件密切相关,还参与冠状动脉粥样硬化发生,同时导致患者生活质量下降(近半数伴焦虑抑郁)。但我国仅不足7%的CMD患者获得正确治疗,诊疗困境突出。文章结合最新研究进展,系统综述CMD的多机制发病基础、非特异性临床表现、诊断难点及治疗现状,旨在为临床精准诊疗提供参考,并明确该领域未来研究方向。

Abstract:

Ischemic heart disease (IHD) is the leading cause of death worldwide. Although coronary intervention has significantly improved the prognosis of patients with obstructive coronary heart disease, nearly three-quarters of patients with angina pectoris are diagnosed with ischemia with non-obstructive coronary artery disease (INOCA). Among these, coronary microcirculation dysfunction (CMD) is the primary mechanism underlying angina pectoris and myocardial ischemia in INOCA patients, accounting for approximately two-thirds of all INOCA cases. Notably, the prevalence rate in women (ranging from 56% to 82%) is significantly higher than that in men. CMD is not only closely associated with adverse cardiovascular events such as heart failure, myocardial infarction, and sudden cardiac death, but also contributes to the development of coronary atherosclerosis. Additionally, it leads to a decline in patients’ quality of life, with nearly half of CMD patients experiencing anxiety and depression. However, only less than 7% of CMD patients in China receive appropriate treatment, highlighting prominent challenges in diagnosis and management. Based on the latest research progress, this article systematically reviews the multi-mechanistic pathogenic basis, non-specific clinical manifestations, diagnostic difficulties, and current treatment status of CMD. It aims to provide references for clinical precise diagnosis and treatment, and clarify the future research directions in this field.