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2017 年第 8 期 第 12 卷

多发性大动脉炎累及冠状动脉的临床特点分析

Clinical features of Takayasu′s arteritis complicated with coronary artery lesions

作者:徐冠一刘文娴杨鲲朱佳佳任燕龙

英文作者:Xu Guanyi Liu Wenxian Yang Kun Zhu Jiajia Ren Yanlong

单位:100029首都医科大学附属北京安贞医院心内科

英文单位:Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词:多发性大动脉炎;冠状动脉;冠状动脉粥样硬化性心脏病

英文关键词:Takayasu′sarteritis;Coronaryartery;Coronaryatheroscleroticheartdisease

  • 摘要:
  • 【摘要】

    目的   研究多发性大动脉炎(TA)累及冠状动脉的临床特点。方法  本研究采用回顾性病例分析的方法,连续入选2003年7月至2015年6月于首都医科大学附属北京安贞医院住院治疗的474例TA患者的临床资料,筛选明确合并冠状动脉受累者62例作为观察组。选取同期住院的普通冠状动脉粥样硬化性心脏病患者124例为对照组。记录并分析患者的临床资料、动态红细胞沉降率(ESR)和C反应蛋白(CRP)指标以及冠状动脉病变特点。结果  观察组中女性患者较多,合并高脂血症病史、糖尿病病史、吸烟史的患者较少,ESR>20 mm/1 h及CRP>15 mg/L的患者较多,与对照组比较差异均有统计学意义[67.7%(42/62)比23.6%(28/124)、17.7%(11/62)比41.9%(52/124)、3.2%(2/62)比26.6%(33/124)、4.8%(3/62)比41.1%(51/124)、35.5%(22/62)比3.2%(4/124)、46.7%(29/62)比16.9%(21/124)](均P<0.05)。2组患者各心血管临床症状差异均无统计学意义(均P>0.05)。观察组患者除心血管症状外的伴随症状以头痛及四肢疼痛[66.1%(41/62)]、乏力[58.1%(36/62)]、高血压[56.1%(35/62)]为多见。观察组中共发现142处冠状动脉病变(单支狭窄大于50%),对照组中共发现180处。观察组左主干病变及冠状动脉开口处受累比例明显多于对照组[8.5%(12/142)比3.3%(6/180)、40.1%(57/142)比7.2%(13/180)](P<0.01);而冠状动脉近段和中段受累比例明显少于对照组[18.3%(26/142)比32.8%(59/180)、21.1%(30/142)比35.6%(64/180)]。结论  TA累及冠状动脉多见于女性,合并的心血管危险因素较少,血管病变更多累及患者的左主干及冠状动脉开口处。

  • Objective  To analyze clinical features of Takayasu′s arteritis(TA) patients complicated with coronary artery lesions. Methods  Four hundreds and seventy-four TA patients who were admitted in Beijing Anzhen Hospital, Capital Medical University from July 2003 to June 2015 were retrospectively analyzed; 62 patients with coronary artery involvement were selected as observation group. One hundred and twenty-four patients with coronary atherosclerotic heart disease were selected as control group. Clinical data, erythrocyte sedimentation tate(ESR), C-reactive protein(CRP) and features of coronary artery lesions were analyzed. Results  There were more female patients in observation group; there were less patients with hyperlipemia history, diabetes history, smoking and more patients with ESR>20 mm/1 h and CRP>15 mg/L than those in control group[67.7%(42/62) vs 23.6%(28/124), 17.7%(11/62) vs 41.9%(52/124), 3.2%(2/62) vs 26.6%(33/124), 4.8%(3/62) vs 41.1%(51/124), 35.5%(22/62) vs 3.2%(4/124), 46.7%(29/62) vs 16.9%(21/124)]; the differences were significant(P<0.05). Cardiovascular symptoms had no significant differences between groups(P>0.05). Headache and pain of limbs[66.1%(41/62)], hypodynamia[58.1%(36/62)] and hypertension[56.1%(35/62)] were common symptoms in patients with TA involving coronary artery. Left main coronary and coronary ostium involving rates in observation group were significantly higher than those in control group[8.5%(12/142) vs 3.3%(6/180), 40.1%(57/142) vs 7.2%(13/180)](P<0.01); proximal coronary artery and middle coronary artery involving rates in observation group were significantly lower than those in control group[18.3%(26/142) vs 32.8%(59/180), 21.1%(30/142) vs 35.6%(64/180)](P<0.05). Conclusion  Takayasu arteritis complicated with coronary artery lesions is more common in female, left main coronary artery and coronary ostium.

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