冷加压试验在缺血性非梗阻性冠心病中的应用评价——病例报告

Evaluation of the Cold Pressor Test in Ischemic Non-Obstructive Coronary Artery Disease: A Case Report

摘要: 目的：评价冷加压试验联合冠状动脉造影与核素心肌灌注显像在缺血伴非阻塞性冠状动脉疾病中的应用价值。方法：回顾分析1例57岁反复胸闷患者，行冠状动脉电脑断层血管摄影术(Computed tomography angiography, CTA)、冠脉造影、冷加压试验及多模式核素心肌灌注显像检查。结果：患者冠状动脉呈轻度粥样硬化，无阻塞性病变，冠脉慢血流阳性；冷加压后血管反应性增高、慢血流加重；核素显像提示静息缺血、微血管储备受损及心内膜下缺血，冷加压后缺血范围显著扩大，符合微血管痉挛表现。结论：冷加压试验联合影像学检查可有效识别缺血伴非阻塞性冠状动脉疾病的功能异常类型，对临床精准诊断与个体化治疗具有重要意义。

Abstract: Objective: To evaluate the application value of cold pressor test combined with coronary angiography and myocardial perfusion imaging in ischemia with non-obstructive coronary arteries. Methods: A 57-year-old patient with recurrent chest distress was retrospectively analyzed, who underwent coronary CTA, coronary angiography, cold pressor test and multimodal myocardial perfusion imaging. Results: The patient had mild coronary atherosclerosis without obstructive lesions, and coronary slow flow was positive. After cold pressor test, vascular reactivity increased and slow flow was aggravated. Myocardial perfusion imaging showed resting ischemia, impaired microvascular reserve and subendocardial ischemia, and the ischemic range expanded significantly after cold pressor test, consistent with microvascular spasm. Conclusion: Cold pressor test combined with imaging can effectively identify the functional abnormality types of ischemia with non-obstructive coronary arteries, which is of great significance for accurate clinical diagnosis and individualized treatment.