冠状动脉微循环障碍机制与治疗的 研究进展

Research Progress on the Mechanisms and Treatment of Coronary Microvascular Dysfunction

摘要: 传统观点认为，心肌梗死与心肌缺血主要源于动脉粥样硬化和心外膜冠状动脉的阻塞性病变，然而，越来越多的临床实践发现，多达半数因心绞痛或缺血证据接受冠脉造影的患者，并未发现明显的阻塞性病变。在此类患者中，冠脉微循环血流受损已被证实是导致心肌缺血的关键机制。冠状动脉系统由心外冠状动脉血管和冠状动脉微循环组成。冠状动脉微血管功能障碍(CMD)致病机制复杂，常导致冠状动脉微循环的功能和结构发生变化。CMD存在于多种心血管疾病进程中，如阻塞性冠状动脉缺血、心肌病、高血压和心力衰竭。本文旨在对冠脉微循环障碍机制与治疗的研究进展做一综述，以期探讨更多相关治疗靶点。

Abstract: Traditional viewpoints have held that myocardial infarction and myocardial ischemia primarily result from atherosclerosis and obstructive lesions in the epicardial coronary arteries. However, increasing clinical practice reveals that up to half of the patients undergoing coronary angiography for angina or evidence of ischemia do not exhibit significant obstructive lesions. In such patients, impaired coronary microcirculatory blood flow has been confirmed as a key mechanism leading to myocardial ischemia. The coronary arterial system comprises the epicardial coronary arteries and the coronary microcirculation. The pathogenic mechanisms of Coronary Microvascular Dysfunction (CMD) are complex, often leading to functional and structural changes in the coronary microcirculation. CMD is present in the progression of various cardiovascular diseases, such as obstructive coronary ischemia, cardiomyopathy, hypertension, and heart failure. This article aims to provide a review of the research progress on the mechanisms and treatment of coronary microcirculation disorders, hoping to explore more relevant therapeutic targets.