酷似系统性血管炎的胆固醇结晶栓塞综合征临床分析  

Case series of patients with cholesterol crystal embolism syndrome that mimics systemic vasculitis

作　　者：欧阳志明[1] 曾文橙 梁锦坚[1] 李谦华[1] 郑东辉[1] 韦秀宁[1] 戴冽[1] 莫颖倩[1] Ouyang Zhiming;Zeng Wencheng;Liang Jinjian;Li Qianhua;Zheng Donghui;Wei Xiuning;Dai Lie;Mo Yingqian(Department of Rheumatology and Immunology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院风湿免疫科,广州510120

出　　处：《中华风湿病学杂志》2021年第9期597-604,I0002,共9页Chinese Journal of Rheumatology

基　　金：中山大学高校基本科研业务费-青年教师培育项目(20ykpy103)。

摘　　要：目的提高风湿免疫科医生对胆固醇结晶栓塞综合征(CCE)的认识。方法总结40例中国CCE患者的临床特点。结果纳入研究的40例患者中,男性35例占87.5%,平均年龄(68±6)岁,均为严重动脉粥样硬化患者。87.5%(35例)的患者有血管腔内介入、血管外科操作、抗凝、溶栓等明确诱因。临床表现包括肾功能不全36例(90.0%)、蓝趾33例(82.5%)、足趾溃疡坏疽10例(25.0%)和网状青斑6例(15%)等。25例患者检测了炎症指标,其中21例(84.0%)患者CRP升高,14例(56.0%)患者ESR升高。结论严重动脉粥样硬化患者诊断原发性系统性血管炎时需鉴别CCE。Objective To improve the awareness of cholesterol crystal embolism syndrome(CCE)inrheumatologists.Methods The clinical characteristics of 40 Chinese CCE patients admitted to our department(one case)were summarize and in the literature(thirty-nine cases)were reviewed.Results Among these 40 patients,87.5%(35/40)were male and the mean age was(68±6)years.All patients suffered from athero-sclerosis and 87.5%(35/40)of them had precipitating factors such as endovascular intervention,vascular surgery,anticoagulant,or thrombolytic therapy.The clinical manifestations included renal insufficiency(90.0%,36/40),blue toe syndrome(82.5%,33/40),ulceration or gangrene(25.0%,10/40),and livedo reticularis(15%,6/40).Acute phase reactant was tested in 25 cases,of whom 84.0%(21/25)showed elevated C-reactive protein(CRP)and 56.0%(14/25)showed elevated erythrocyte sedimentation rate(ESR).Conclusion Rheumatologists should be alert that CCE is one of the differential diagnosis of systemic vasculitis,especially for patients with severe atherosclerosis.

关 键 词：动脉粥样硬化 系统性血管炎 胆固醇结晶栓塞综合征 

分 类 号：R543[医药卫生—心血管疾病]