大动脉炎累及冠状动脉临床特点及预后分析

摘要

目的:探讨大动脉炎累及冠状动脉(冠脉)的临床特点、治疗及潜在的诊治难点.方法:回顾性分析我院1998-10~2011-12年住院的连续580例大动脉炎患者中,经冠脉造影证实冠脉病变狭窄大于50%的病例,对其临床特点、治疗及随访情况进行总结.结果:大动脉炎累及冠脉共43例,男性7例,女性36例,占同期住院大动脉炎患者的7.4% (43/580);心脏症状发作年龄15~64(41.0±13.2)岁.40例患者有典型心绞痛发作病史,其他主要症状包括外周血管杂音、无脉症和高血压.心电图示病理性Q波16例,ST-T缺血性改变33例,超声心动图示左室壁节段性运动异常10例,血沉升高27例.大动脉炎最常累及冠脉开口及近端,血管造影能明确诊断.1例冠脉造影时猝死,9例行血管内介入治疗,13例行冠脉旁路移植术.平均随访(5.8± 3.3)年,死亡8例.结论:大动脉炎可累及冠状动脉,易导致心血管事件,严重病变应尽早行血运重建.%Objective;To explore the clinical features, Lrealmenl and potential difficulties in daily practice for patients of Takayasu' s arteritis with coronary artery involvement.rnMethods;We retrospectively analyzed 580 consecutive patients with Takayasu' s arteritis who were admitted in our hospital from 1998 to 2011. Among them,we further studied the patients with coronary artery stenosis greater than 50% which was confirmed by coronary angiography,and summarized their clinical features, treatment and follow-up outcomes.rnResults:There were 43/580 patients (7. 4% ) with coronary involvement including 7 male and 36 female, the mean age for their onset of cardiac symptoms was at (41.0±13. 2) years (15 ~ 64 years). 40 cases had typical angina, and the other main symptoms included bruit of peripheral vessel, pulseless and hypertension. 16 cases had pathologic Q wave and 33 had ST-T ische-mic changes in electrocardiography. 10 cases presented segmental left ventricular wall motion abnormality by echocardiography and 27 cases showed elevated erythrocyte sedimentation rate. The ostia and proximal segment of coronary were the most frequently involved sites,peripheral and coronary angiography could diagnose clearly. 1 patient had sudden death during coronary angiography. 9 patients received stents implantation, and 13 received coronary artery bypass grafting. The mean follow-up time was (5. 8 ± 3. 3) years,and 8 patients died.Conclusion:The patients with akayasu' s arteritis could involve coronary artery, and therefore, cause cardiovascular events. Serious lesions should receive revascularization at the early stage.