大动脉炎累及冠状动脉的分析

目的　调查大动脉炎累及冠状动脉病例的临床特点、治疗和随访情况 ,探讨其潜在的诊治难点。方法　回顾性分析我院 1 998～ 2 0 0 1年住院的连续 1 2 1例大动脉炎患者中 ,因临床上怀疑有冠状动脉受累 ,经血管造影证实冠状动脉病变狭窄大于 50 %的病例 ,并进行跟踪随访。结果　大动脉炎累及冠状动脉共 1 0例 ,占同期住院大动脉炎患者的 8 2 6 % (1 0 / 1 2 1 ) ;男性 1例 ,女性 9例 ,年龄1 9～ 45(31± 9)岁。均有外周动脉病变的证据并有心绞痛发作 ,心电图示病理性Q波 5例 ,ST T缺血性改变 2例 ,超声心动图示左室壁节段性运动异常 5例 ,血管造影能明确诊断 ,最常见狭窄部位是冠状动脉开口。血运重建治疗可改善患者的心绞痛 ,其远期疗效及生存率有待进一步调查。结论　大动脉炎可累及冠状动脉 ,临床上要予以重视

A study of coronary artery involvement in aortitis

OBJECTIVE: To investigate the clinical features, treatment and prognosis of coronary artery involvement resulting from aortoarteritis and discuss the potential difficulties in the diagnosis and treatment of the disease. METHODS: Of 121 consecutive hospitalized patients with aortoarteritis from 1998 to 2001, the patients, who were found to have more than 50% diameter reduction of coronary artery by angiography because of clinically suspected coronary artery involvement, were studied retrospectively. RESULTS: In the study, there were totally 10 cases with coronary artery involvement of aortoarteritis, which accounted for 8.26% (10/121) of all the hospitalized patients with aortoarteritis. Nine of the 10 cases were female, aged 19 - 45 (31 +/- 9) years. There were evidences of peripheral arterial lesions and angina pectoris in all the cases. Of the 10 cases, 7 had abnormal electrocardiography and 5 abnormal echocardiography. Aortic root angiography or coronary angiography was the most useful tool for definitive diagnosis. Coronary ostia were most frequently involved. Coronary revascularization improved angina pectoris in most of the patients. However, the long-term efficacy and survival rate should be investigated further. CONCLUSION: Coronary artery may be involved in aortoarteritis. Appropriate measurements should be taken to detect and to treat the lesion.