摘要
目的:探讨冠状动脉、肺动脉同时受累的多发性大动脉炎的临床特点,以提高对该病的认识。方法:对2例诊断为冠状动脉、肺动脉同时受累的多发性大动脉炎患者的进行回顾性分析并文献复习。结果:2例患者均有主动脉及分支不同程度、部位的受累,例1患者合并右冠状动脉主干开口管腔重度狭窄,右肺动脉闭塞。例2患者左冠状动脉主干管腔次全闭塞,右冠状动脉开口处管壁不规则增厚,右上肺动脉及其分支闭塞,2例患者均经激素免疫抑制剂等治疗,症状改善。经文献检索国外报道2例冠状动脉、肺动脉同时受累的大动脉炎病例,复习文献发现:计算机断层扫描血管成像(CTA)、磁共振血管成像(MRA)和正电子发射计算机断层/计算机断层扫描(PET/CT)可用于早期诊断及炎症活动的评估,术前术后的免疫抑制治疗是手术成功的关键。结论:冠状动脉、肺动脉同时受累的大动脉炎患者,血管病变广泛,心血管事件发生率高,预后极差。因此应提高临床医师对该病的早期诊断意识,规范免疫抑制治疗,必要时介入及手术干预,改善患者预后。
Objective： To enhance the understanding of Takayasu＇s arteritis（ TA） with coronary and pulmonary involvement through the analyses on clinical features. Method ： A retrospective analysis of 2 patients with TA diagnosed as coronary artery and pulmonary artery involvement and literature review was performed.Results： All the 2 patients had different degrees of involvement of the aorta and its branches. 1 of the patients had severe stenosis of the right coronary trunk opening,and the right pulmonary artery was occluded. In 2 patient,the left main coronary artery lumen was occluded,the right coronary artery was irregularly thickened,the right upper pulmonary artery and its branches were occluded. 2 patients were treated with hormone immunosuppressive agents,and the condition had improved. There are2 cases of TA with coronary and pulmonary involvement reported by literature search. Review of literature demonstrated that： computed tomography angiography（ CTA） and magnetic resonance angiography（ MRA） and positron emission tomography/computed tomography（ PET/CT） could be used for early diagnosis and evaluation of inflammatory activity,The immune-suppressive therapy of preoperative and postoperative was critical to the success of the operation. Conclusion： Patients with TA with coronary artery and pulmonary artery involvement are characterized by extensive lesions and high incidence of cardiovascular events. and the prognosis is very poor. Therefore,the awareness of early diagnosis should be improved,immunesuppressive therapy should be standardize,interventional and surgical treatment were implemented if necessary,and improve the prognosis of the patients.
作者
肖瑶
杨京华
李宇
张颖
王增智
李杰
XIAO Yao;YANG Jinghua;LI Yu;ZHANG Ying;WANG Zengzhi;LI Jie(Department of Respiratory and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Belting 100029, Chin)
出处
《心肺血管病杂志》
2018年第3期186-192,共7页
Journal of Cardiovascular and Pulmonary Diseases
关键词
大动脉炎
冠状动脉
肺动脉
Takayasu＇s arteritis
coronary artery
pulmonary artery
