【摘要】：目的:初步探究累及冠狀動(dòng)脈的多發(fā)性大動(dòng)脈炎(Takayasu arteritis,TA)患者的臨床特點(diǎn),試探討累及冠狀動(dòng)脈的多發(fā)性大動(dòng)脈炎患者的治療對(duì)策方法:本研究采用回顧性病例研究的方法,收集自2003年7月至2015年6月期間于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院內(nèi)住院治療的多發(fā)性大動(dòng)脈炎患者的臨床資料,建立資料庫(kù),選取合并冠狀動(dòng)脈疾病:心絞痛、心肌梗死或無癥狀冠狀動(dòng)脈狹窄、瘤樣擴(kuò)張的患者,根據(jù)“冠狀動(dòng)脈CTA及冠狀動(dòng)脈造影”對(duì)患者進(jìn)行分類,收集患者相關(guān)臨床治療。利用統(tǒng)計(jì)軟件進(jìn)一步分析累及冠狀動(dòng)脈的多發(fā)性大動(dòng)脈炎患者的客觀數(shù)據(jù)(包括年齡、性別、家族史、治療方式、手術(shù)情況、患病時(shí)間、一般癥狀、血管累及情況、冠狀動(dòng)脈受累情況、血清學(xué)檢查、影像學(xué)檢查等數(shù)據(jù))探索多發(fā)性大動(dòng)脈炎累及冠狀動(dòng)脈患者的臨床特點(diǎn)以及治療與管理。結(jié)果:此次研究共收集62例多發(fā)性大動(dòng)脈炎累及冠狀動(dòng)脈患者資料,其中男性20例,女性42例,男女發(fā)病比為1:2.1。多發(fā)性大動(dòng)脈炎累及冠狀動(dòng)脈患者組合并的心血管危險(xiǎn)因素較少(p0.05)。44例患者初發(fā)癥狀為心絞痛�；加行募」Ｋ�(急性及陳舊性心肌梗死)的患者有8例。心血管癥狀無明顯差異(p0.05)共發(fā)現(xiàn)142處冠狀動(dòng)脈病變(單支狹窄大于50%)。開口處冠狀動(dòng)脈受累最為常見,高于普通冠心病患者(p0.05)。而在治療上:共有33例患者接受了冠狀動(dòng)脈介入治療。16名患者接受了手術(shù)血管旁路重建術(shù)。還有13例患者只接受了藥物的保守治療。遠(yuǎn)期隨訪中共發(fā)現(xiàn)再狹窄病例27人次,其中介入支架組出現(xiàn)再狹窄的患者共有11人(17人次),介入下單純球囊擴(kuò)張術(shù)組出現(xiàn)再狹窄的患者共有11人(13人次)。而對(duì)于冠狀動(dòng)脈搭橋組,出現(xiàn)再狹窄的患者共有5人(5人次)。介入治療的再狹窄率高于冠狀動(dòng)脈搭橋術(shù)(p0.05)。結(jié)論:通過對(duì)我院多發(fā)性大動(dòng)脈炎住院患者臨床資料的回顧性分析,初步認(rèn)為:多發(fā)性大動(dòng)脈炎合并冠狀動(dòng)脈受累多見于青中年女性,平均年齡為45歲,多發(fā)性大動(dòng)脈炎患者早期癥狀不具有特異性,以頭痛、發(fā)熱、乏力為最常見旨發(fā)癥狀。多發(fā)性大動(dòng)脈炎的患者往往與常見的冠狀動(dòng)脈粥樣硬化性心臟病的患者相比有較少的危險(xiǎn)因素,而在冠狀動(dòng)脈病變引起的臨床表現(xiàn)上沒有明顯區(qū)別。多發(fā)性大動(dòng)脈炎多累及患者血管的開口部。關(guān)于冠脈病變的治療上,血管內(nèi)介入手術(shù)是最常用的手段,但術(shù)后再狹窄率較高。冠狀動(dòng)脈搭術(shù)較血管介入治療再狹窄率明顯下降。糖皮質(zhì)激素和(或)細(xì)胞毒性藥物可以降低血管內(nèi)介入手術(shù)、外科手術(shù)的再狹窄率,可有效控制疾病活動(dòng)、改善預(yù)后。
[Abstract]:Objective: to investigate the clinical characteristics of patients with Takayasu arteritis (Takayasu arteritis,TA) involving coronary artery, and to explore the treatment strategies of patients with Takayasu arteritis involved in coronary artery. The clinical data of patients with Takayasu arteritis hospitalized in Anzhen Hospital affiliated to Capital Medical University from July 2003 to June 2015 were collected. To establish a database of patients with coronary artery diseases: angina pectoris, myocardial infarction or asymptomatic coronary artery stenosis, tumor-like dilatation, according to the "coronary artery CTA and coronary angiography", the patients were classified, and the relevant clinical treatment of the patients was collected. The objective data (including age, sex, family history, treatment, operation, disease time, general symptoms, vascular involvement, coronary artery involvement, serological examination, imaging examination, etc.) were further analyzed by statistical software to explore the clinical characteristics, treatment and management of patients with Takayasu arteritis involved in coronary artery disease (including age, sex, family history, treatment, operation, disease time, general symptoms, vascular involvement, coronary artery involvement, serological examination, imaging examination, etc.). Results: a total of 62 patients with multiple arteritis involved in coronary artery were collected in this study, including 20 males and 42 females. The ratio of male to female was 1 鈮，

本文編號(hào)：2505058