大动脉炎累及冠状动脉7例临床分析

目的 :分析大动脉炎累及冠状动脉的患者的发病率、临床特点、冠状动脉病变性质及治疗效果 ,为临床提供参考。方法 :1990～ 2 0 0 2年 5 2例大动脉炎住院患者中 7例 (女 5例、男 2例 )患者 ,根据其临床表现、辅助检查、大血管造影及冠状动脉造影 ,证实为大动脉炎累及冠状动脉 ,予以激素、扩管等对症治疗 ,随访观察患者症状、心功能、炎症指标等病情变化。结果 :7例患者中 6例有不同程度的心肌缺血症状 ,2例出现心肌梗死 ,3例出现心力衰竭症状。 1例冠状动脉造影显示为左旋支中段中度狭窄 ,1例为左冠状动脉前降支开口处重度狭窄 ,另1例MRI和磁共振血管造影示广泛前壁心肌梗死。经对症治疗后 ,患者血沉、C反应蛋白均能回复正常 ,而症状与心功能无明显改善。结论 :多发性大动脉炎累及冠状动脉并不少见 ,可发生于冠状动脉开口与近端 ,亦可累及中段 ,随病程延长 ,患者心脏情况恶化 ,临床上应对有心肌缺血症状的大动脉炎患者积极行冠状动脉造影 ,早期诊断 ,积极治疗。

The clinical manifestation of 7 aorta-arteritis cases with coronary artery involvement and follow-up study

Objective:To analyze the clinical spectrums of aorta arteritis patients with the involvment of coronary arteries.Methods:Fifty two aorta arteritis cases between 1990 and 2002 were reviewed, coronary artery impairments in 7 patient with aorta arteritis were confirmed by clinical manifestations, angiographies and other examinations.Results:Of the seven cases, six presented myocardial ischemia symptoms, two had myocardial infarction, three developed cardiac failure. In angiography, one case showed stenosis in the middle section of left circumflex branch, other showed stenosis at ostium of left anterior descending branch. Active therapy was useful in decreasing ESR and CRP to normal, but it does little to improve the symptoms or cardiac function.Conclusion:It's not unusual that coronary artery is involved in aorta ateritis. Besides the ostium or proximal section previously reported, the lesion can also locate at the middle section of coronary artery. The heart condition will deteriorate with the progresses of the disease, so coronary arteriography should be carried out as early as possible in the aorta arteritis patients with myocardial ischemia symptoms.