慢性肾衰竭合并冠状动脉扩张症致急性心肌梗死1例  

Acute myocardial infarction caused by chronic renal failure complicating coronary artery dilatation:a case report

作　　者：张志敏[1] 黎燚华 康亮 褚庆民[2] 李荣[2] ZHANG Zhimin;LI Yihua;KANG Liang;CHU Qingmin;LI Rong(First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510000,China;Department of Cardiology,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510000,China)

机构地区：[1]广州中医药大学第一临床医学院,510405 [2]广州中医药大学第一附属医院心血管科,510405

出　　处：《重庆医学》2022年第21期3665-3669,共5页Chongqing medicine

基　　金：广东省自然科学基金项目(2017A030313745);广东省中医药局项目(20181087);广东省医学科学技术研究基金项目(A2018222)。

摘　　要：该文报道了1例慢性肾衰竭(CKD)患者在血液透析后出现心肌梗死(AMI),后经冠状动脉造影检查(CAG)证实为冠状动脉扩张症(CAE)的案例,并结合相关研究试阐释其发生机制。该CAE患者冠状动脉血流缓慢引起心肌缺血是其病理生理基础,在行血液透析后血容量减少导致心肌缺血加重可能是该患者发生AMI的机制。另外,高同型半胱氨酸血症、高胱抑素CysC水平、高尿酸血症及由于长期透析所导致的钙磷代谢异常、肾性贫血、低蛋白水平亦是CKD患者发生心血管疾病的重要危险因素。对于CAE引起的心绞痛,硝酸酯类药物无效甚至会加重病情,而β-受体阻滞剂可能是更优的选择。The patients with have a higher risk of developing and its pathogenesis is not limited to coronary artery stenosis or occlusion.This paper reports a case of chronic renal failure(CKD)who occured acute myocardial infarction(AMI),this patient appeared AMI after hemodialysis,later this patient was definitely verified as coronary artery ectasia(CAE)by coronary angiography(CAG),its pathogenesis was elucidated by combining with the related studies.The slow coronary blood flow caused myocardial ischemia was its pathophysiological basis,the blood volume decrease after hemodialysis leading to myocardial ischemia aggravation might be the mechanism of AMI occurrence.In addition,hyperhomocysteinemia,high homocystatin C(CysC)levels,hyperuricemia,calcium and phosphorus metabolism abnormality,renal anemia and low protein levels caused by long-term hemodialysis were also the important risk factors for cardiovascular disease occurrence in CKD patients.For angina pectoris induced by CAE,nitrates were ineffective or even could aggravated the disease state,while beta-blockers may be the better choice.

关 键 词：慢性肾衰竭 冠状动脉扩张症 急性心肌梗死 硝酸甘油 Β-受体阻滞剂 

分 类 号：R542.22[医药卫生—心血管疾病]