系统性血管炎合并冠心病患者的冠状动脉病变及临床特征

目的 阐述系统性血管炎合并冠状动脉病变患者的临床和冠状动脉病变特征.方法 对北京协和医院1999年1月至2009年10月有冠状动脉造影结果的15例系统性血管炎合并冠心病患者的临床表现及冠状动脉病变进行回顾性分析.结果 15例患者中,贝赫切特综合征(BS)6例、变应性肉芽肿性血管炎(CSS)3例,大动脉炎2例,结节性多动脉炎(PAN)、显微镜下多血管炎(MPA)、Wegener肉芽肿(WG)和川崎病各1例.15例患者出现冠心病表现的平均年龄(39.3±11.9)岁.与在血管炎非活动期出现冠状动脉事件的患者(4例)相比,在血管炎活动期出现冠状动脉事件的患者(9例)有以下趋势:发病年龄小[(32.4±8.1)岁比(47.0±10.2)岁],传统冠心病危险因素少[(1.2±1.5)个比(2.8±1.7)个],血管炎和冠心病发病间隔短[0～7(平均1.6)年比3～30(平均17.7)年].15例患者中,表现为急性心肌梗死12例,心绞痛2例,心包填塞1例;3例发生急性冠状动脉事件时合并严重心律失常,3例合并急性左心功能不全.冠状动脉造影检查8例患者表现为冠状动脉狭窄、闭塞,1例表现为动脉瘤及急性血栓形成,1例表现为多发冠状动脉瘤样扩张伴闭塞,2例表现为冠状动脉痉挛,另有3例急性心肌梗死患者冠状动脉狭窄程度＜70%.8例患者超声心动图检查左心室射血分数＜50%.结论 多种系统性血管炎可合并冠状动脉病变,临床上可以表现为危急重症,冠状动脉狭窄或闭塞、动脉瘤形成、痉挛、急性血栓形成和小血管病变共同参与发病.

Abstract：

Objective To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease. Method Fifteen patients ( 11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed. Results There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39. 3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32. 4 ± 8. 1 )years vs. (47.0 ± 10. 2)years],had less risk factors for atherosclerosis ( 1.2 ± 1. 5 to 2. 8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 -7 years( average 1.6 years) to 3 -30 years( average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by eehocardiography was less than 50% in 8 patients. Conclusion Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.

Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease

Objective To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease. Method Fifteen patients ( 11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed. Results There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39. 3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32. 4 ± 8. 1 )years vs. (47.0 ± 10. 2)years],had less risk factors for atherosclerosis ( 1.2 ± 1. 5 to 2. 8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 -7 years( average 1.6 years) to 3 -30 years( average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by eehocardiography was less than 50% in 8 patients. Conclusion Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.