Syndrome-X（normal coronary angina syndrome）の検討—女性冠動脈疾患より見て

Clinical study of Syndrome-X (normal coronary abgina syndrome):Perspectives from coronary disease of female

　女性の冠動脈疾患は，年齢，性，危険因子において男性のそれと相違があることは既に示され，女性が高年になるに従い性差が少なくなることも指摘されている。また若年期の女性については，冠動脈疾患の低率な事と同時に，その診断上の問題点も存在する。すなわち従来syndrome-Xとして示されたような，正常冠動脈にて狭心症様の症状，心電図変化を示す群を含めて，負荷テスト陽性者の多い点である。これまでの点に関して，スクリーニングする術を知らず，原因についても多様の臆測がなされたが正確な点については不明である。今回当院にて，このsyndrome-Xについての調査にて興味ある知見，すなわち，Blood Volumeが関与している可能性を知ったので報告したい。

We studied normal coronary angina syndrome. as is said in Japan "Syndrome-X ". We strictly decided the criteria of this syndrome as follows, (1) ST ischemic change more than O.1 mV by exercise ECG, and it should be repeatedly demonstrated. (2) Coronary angiography revealed no coronary narrowing nor LVG's abnormal wall motion. (3) Effort angina like chest pain on exercise. Among 199 patients studied CAG and LVG, 13 patients were included to this group and all were female. The age varied from 37 to 70 and mean age was 56.7. These patients tookno digitalis nor contraceptives, had no anemia but one, no hemorrhagic tendency, and no serum potassium abnormality. Three patients showed hypertension. Risk scores of this group were rather lower than ischemic group. We found by this clinical study that: (1) they have good heart function at rest, and Tr-1 (Pulmonary circulation time) was shorter than 6.4 seconds, and Blood Volume was lower than 2500 ml/m² (P<0.01). (2) Blood pressure increasing ratio by ergometer was higher than normal or ischemic group (P<0.01). The hypothesis favored to ex-plain these findings is that of a lowered blood volume-induced increase in venous tone and re-sulted arterial tone by exercise. The mismatch of lowered venous return and higher arterial and afterload reaction would account for the occur-rence of normal coronary angina syndrome. Female menstrual or hormonal reaction to vas-cular tone might be an adjective of these pheno-menon.