血友病A合并急性心肌梗死1例并尸解报道和文献复习

A case of hemophilia A and acute myocardial infarction:autopsy report and review of the literatures

1例男性血友病患者因胸痛就诊,18个小时后死亡。尸体解剖结果:冠状动脉粥样硬化性心脏病、急性心肌梗死、陈旧性心肌梗死、急性肺水肿。复习相关文献可见,血友病发生心肌梗死自1959年首次报道以来,迄今国外有30多例报道,但在我国还没有相关报道。血友病是先天性出血性疾病,发生血栓性疾病包括急性心肌梗死极为罕见。血友病发生急性心肌梗死者常有高血压、高血脂、糖尿病、肥胖、吸烟等冠心病危险因素,因子替代治疗时更易发生。血友病发生急性心肌梗死可在全面评估患者的情况后进行冠脉介入治疗,有效的治疗方法仍需进一步探讨。

A male case of hemophilia A died on 18th hour after admission to Emergency Department because of chest pain. His autopsy reports coronary atherosclerotic heart disease, acute myocardial infarction, old myocardial infarction, acute pulmonary edema. Reviews of the literatures shows that there are more than 30 cases of myocardial infarction in hemophilia A patients after the first report in 1959 globally except for China. Because Hemophilia A is a congenital disease of hemorrhagic diathesis, thrombosis e.g. acute myocardial infarction are rare in those patients. Patients of hemophilia A with acute myocardial infarction often have risk factors of coronary heart disease such as hypertension, hyperlipidemia, diabetes mellitus, obesity and smoking, especially receiving factor Ⅷ replacement therapy. Those patients should be treated with percutaneous coronary intervention （PCI） after systematic evaluation, but effective therapy need be researched further.