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：

• 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.