自发性冠状动脉壁内血肿及夹层所致急性冠脉综合征的临床特征及转归  

Analysis of 26 cases of acute coronary syndrome with spontaneous coronary artery hematoma and spontaneous coronary artery dissection

作　　者：汤祥林 徐世坤 王齐兵[1,2] 黄浙勇 张书宁[1,2] 姚康 戴宇翔 陆浩[1,2] 张峰 钱菊英[1,2] 葛均波 Tang Xianglin;Xu Shikun;Wang Qibing;Huang Zheyong;Zhang Shuning;Yao Kang;Dai Yuxiang;Lu Hao;Zhang Feng;Qian Juying;Ge Junbo(Shanghai Institute of Cardiovascular Diseases,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市心血管病研究所,上海200032 [2]复旦大学附属中山医院心内科,上海200032

出　　处：《上海医药》2019年第1期3-7,共5页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的 :分析自发性冠状动脉壁内血肿及夹层所致急性冠脉综合征患者的临床资料,结合文献回顾,以积累对该病的诊疗经验。方法 :以复旦大学附属中山医院心内科2015年7月—2018年9月收治的经冠状动脉影像学检查明确的自发性冠状动脉壁内血肿及夹层所致急性冠脉综合征患者为对象,分析他们的一般临床资料、临床表现、受累冠状动脉及节段、治疗措施、临床结局和随访期的影像学检查情况。结果 :共计26例患者,其中男7例、女19例,男∶女≈1∶3,平均年龄为(51.6±11.7)岁。男、女患者在心肌肌钙蛋白T、肌酸磷酸激酶同功酶MB、N端脑钠肽前体水平以及左心室射血分数方面均无显著差异。无论是药物保守治疗还是介入治疗,患者的临床结局均较好。结论 :自发性冠状动脉壁内血肿及夹层可能是同一疾病不同阶段的不同表现形式。大多数情况下可首选药物保守治疗,进行介入治疗时则须谨慎评估益处-风险比,以保证血流畅通为主,避免病变延展。药物保守治疗时使用单一抗血小板药物可能即可,但介入治疗后应常规使用双联抗血小板药物。有关抗血小板药物的使用时限尚无定论。Objective:The clinical data from patients with spontaneous coronary artery hematoma(SCAH)and spontaneous coronary artery dissection(SCAD)were analyzed so as to guide their diagnosis and therapy in the future.Methods:Twenty-six cases diagnosed as SCAH/SCAD from July,2015 to September,2018 by the department of cardiology of Zhongshan Hospital were collected as subjects and their clinical characteristics and manifestation,involved coronary segments,therapy,outcome and follow-up angiography were analyzed.Results:The mean age of onset was 51.6±11.7 years old,and the male/female ratio was roughly equal to 1:3(26 patients in total,7 males and 19 females respectively).There were no significant differences between male and female patients in the levels of cardiac troponin T,creatine phosphokinase MB isoenzyme,N-terminal pro-B-type natriuretic peptide and the left ventricular ejection fraction.The outcomes of the patients with either conservative or interventional treatment were excellent.Conclusion:SCAD is the advanced stage of SCAH.Conservative strategy is the best choice in most of time.Even though intervention is unavoidable,the risks of intervention should be taken into consideration.Single antiplatelet treatment is enough for the conservative strategy of SCAH/SCAD,however dual antiplatelet therapy followed by stenting intervention is indispensable.There is no consensus in the duration of antiplatelet therapy.

关 键 词：自发性冠状动脉壁内血肿 自发性冠状动脉夹层 冠状动脉造影检查 

分 类 号：R541.4[医药卫生—心血管疾病]