自发性冠状动脉夹层患者的临床特点及预后分析  

Clinical characteristics and prognosis of patients with spontaneous coronary artery dissection

作　　者：曹天庆 孙一鸣 布兆柯 张亚慧 杨树青 陈明星 CAO Tianqing;SUN Yiming;BU Zhaoke;ZHANG Yahui;YANG Shuqing;CHEN Mingxing(Department of Cardiology,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225001;Department of Cardiology,Yangzhou Clinical Medical College of Xuzhou Medical University,Yangzhou,Jiangsu,225001)

机构地区：[1]扬州大学附属苏北人民医院心内科,江苏扬州225001 [2]徐州医科大学扬州临床医学院心内科,江苏扬州225001

出　　处：《实用临床医药杂志》2025年第5期36-39,44,共5页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金青年项目(82100429);江苏省卫生健康委科研项目(M2021040)。

摘　　要：目的分析自发性冠状动脉夹层(SCAD)患者的临床特点和预后。方法回顾性选取40例住院急性心肌梗死患者作为研究对象,患者住院期间均经冠状动脉造影(CAG)或血管内超声(IVUS)检查确诊SCAD。分析患者的临床特点、CAG或IVUS检查结果、治疗方案,并通过随访评估其预后。结果40例SCAD患者中,男11例、女29例,平均年龄为(53.04±9.15)岁;12例患者有明确发病原因,7例患者以胸痛为首发症状。CAG或IVUS检查结果显示,40例SCAD患者共检出69处SCAD病变,其中15例患者为单处病变。患者主要治疗方式为药物保守治疗,中位随访时间为34个月(范围2~48个月),期间共发生主要不良心脑血管事件(MACCE)5例。根据是否发生MACCE将患者分为MACCE组5例和非MACCE组35例,MACCE组患者的平均年龄、超声心动图显示节段运动异常发生率高于非MACCE组,差异均有统计学意义(P<0.05)。结论SCAD在CAG中具有显著的影像学特征,IVUS可明确诊断。大多数患者采用药物保守治疗,整体预后较好,但年龄较大或超声心动图显示节段运动异常的SCAD患者预后较差。Objective To analyze the clinical characteristics and prognosis of patients with spontaneous coronary artery dissection(SCAD).Methods A retrospective analysis was conducted in 40 patients with acute myocardial infarction(AMI).All patients were diagnosed with SCAD during hospitalization through coronary angiography(CAG)or intravascular ultrasound(IVUS).The clinical characteristics,CAG or IVUS findings,and treatment regimens of the patients were analyzed,and their prognosis was assessed through follow-up.Results Among 40 SCAD patients,there were 11 males and 29 females,with a mean age of(53.04±9.15)years.Twelve patients had identified causative factors,and seven patients presented with chest pain as the initial symptom.CAG or IVUS results showed that a total of 69 SCAD lesions were detected in 40 patients,with 15 patients having a single lesion.The primary treatment approach for the patients was medical therapy.The median follow-up duration was 34 months(ranging 2 to 48 months),during which 5 major adverse cardiovascular and cerebrovascular events(MACCE)occurred.The patients were divided into MACCE group(5 patients)and non-MACCE group(35 patients)based on occurrence of MACCE.The mean age and the incidence of regional wall motion abnormalities on echocardiography were higher in the MACCE group than in the non-MACCE group(P<0.05).Conclusion SCAD has distinct imaging features on CAG,and IVUS can confirm the diagnosis.Most patients are treated with medical therapy and have a generally favorable prognosis.However,patients with older age or regional wall motion abnormalities on echocardiography have poorer prognosis.

关 键 词：自发性冠状动脉夹层 冠状动脉造影 血管内超声 急性心肌梗死 急性冠状动脉综合征 节段运动异常 双重抗血小板治疗 主要不良心脑血管事件 

分 类 号：R542.2[医药卫生—心血管疾病] R453[医药卫生—内科学] R445[医药卫生—临床医学]