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冠状动脉微血管疾病研究进展与挑战
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Abstract:
冠状动脉微血管疾病(CMD)是心肌缺血的独立病因，其机制涉及内皮功能障碍、微血管痉挛、炎症及血管重构等多因素。临床表现为非阻塞性心绞痛，与心血管事件风险升高相关。诊断依赖侵入性功能指标(如CFR、IMR)与非侵入性影像(心脏磁共振、PET)，但标准化不足。治疗以改善微循环为核心，传统药物包括硝酸酯类、尼可地尔(KATP通道开放剂)、雷诺嗪(钠通道抑制剂)及ACEI/ARB，新兴疗法如sGC激动剂和SGLT-2抑制剂展现潜力。目前证据多基于小样本研究，缺乏具体指南，且长期预后仍存在争议。未来需整合多组学、影像标志物与AI技术，建立精准诊疗体系，并通过大规模临床试验验证分层治疗策略。
Coronary microvascular disease (CMD) is an independent cause of myocardial ischemia, and its mechanism involves multiple factors such as endothelial dysfunction, microvascular spasm, inflammation and vascular remodeling. The clinical manifestation is non-obstructive angina, which is associated with an increased risk of cardiovascular events. Diagnosis relies on invasive functional indicators (such as CFR, IMR) and non-invasive imaging (cardiac magnetic resonance, PET), but the standardization is insufficient. The core treatment is to improve microcirculation. Traditional drugs include nitrates, nicorandil (KATP channel opener), ranolazine (sodium channel inhibitor) and ACEI/ARB. Emerging therapies such as sGC agonists and SGLT-2 inhibitors show potential. The current evidence is mostly based on small sample studies, lacks specific guidelines, and long-term prognosis is still controversial. In the future, it is necessary to integrate multi-omics, imaging markers and AI technology to establish a precise diagnosis and treatment system, and to verify the stratified treatment strategy through large-scale clinical trials.
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