原发性血小板增多症导致急性心肌梗死十例临床分析

Essential Thrombocythemia Leads to Acute Myocardial Infarction in Ten Patients

目的探讨原发性血小板增多症导致急性心肌梗死患者的临床特征及其治疗方法。方法对10例确诊为原发性血小板增多症导致急性心肌梗死患者的临床资料及冠脉造影检查结果进行回顾性分析。结果 10例患者的中位血小板计数为890.5×109/L[(630～1250)×109/L]。其中,急性下壁心肌梗死7例(6例犯罪血管为右冠状动脉,1例为回旋支),右室心肌梗死1例(犯罪血管为右冠状动脉),前壁心肌梗死1例(犯罪血管为前降支),高侧壁心肌梗死1例(犯罪血管为回旋支)。冠脉内可见大量血栓,且重度狭窄,2例狭窄程度为85%～100%;冠脉内可见大量血栓,中度狭窄,5例狭窄程度为50%～75%;冠脉内未见明显血栓,冠脉轻度狭窄,程度50%～55%者2例;可见冠脉闭塞,未见血栓1例。10例患者活化血小板α颗粒膜糖蛋白(CD62P)及溶酶体膜糖蛋白(CD63)指标及血小板最大聚集率明显增高,分别为(6.13±0.85)%、(8.39±1.56)%及(81.60±10.20)%。随访半年,4例同时行降低血小板治疗的患者未再发急性冠脉综合征事件,其余患者中有3例患者半年内再次出现急性冠脉综合征表现。3例患者在心肌梗死后常规治疗过程中出现消化道大出血表现。1例患者心肌梗死术后2个月出现下肢动脉栓塞。结论原发性血小板增多症导致急性心肌梗死患者多累及右冠状动脉,多可见大量血栓,复发率高,需同时行降血小板治疗,在临床诊疗过程中需注意其特殊性。

Objective To summarize the clinical characteristics and treatment of acute myocardial infarction（AMI）due to essential thrombocythemia.Methods The clinical data and coronary angiography results of 10 patients who suffered from AMI due to essential thrombocythemia were retrospectively analyzed.Results The median platelet count was 890.5×10^9/L[（630～1250）×10^9/L] Of these 8 patients,7 patients had acute inferior wall myocardial infarction（the criminal vessel was the right coronary artery in 6 cases and the circumflex vessel in 1 case）.1 case had right ventricular myocardial infarction（the criminal vessel was the right coronary blood vessels）,1 case had anterior wall infarction（the criminal vessel was the left anterior descending artery）,and 1 case had high lateral infarction（the criminal vessel was circumflex vessel）.In 2 cases with severe stenosis,a large number of coronary thrombosis was seen in the coronary artery,and the stenosis extent reached 85%～100%.In 5 patients with moderate stenosis,a large number of coronary thrombosis was observed,and the extent of coronary artery stenosis was 50%～75%.In 2 patients with mind stenosis,no obvious coronary thrombosis,was observed,and the extent of coronary stenosis was 50%～55%.In the remaining 1 patient,coronary occlusion was noted but no thrombus was found.In all 10 patients,the levels of activated platelet CD62P [（6.13±0.85）%] and CD63 [（8.39±1.56）%] and the maximum platelet aggregation rate [（81.60±10.20）%] significantly increased.During the half-year follow-up,no acute coronary syndrome was noted in 4 patients who had concurrently received platelet-lowering therapy.Three patients experienced severe gastrointestinal bleeding during conventional treatment after AMI,and one patient suffered from lower extremity arterial thrombosis two months after treatment for AMI.Conclusion In patients who with AMI due to essential thrombocythemia,right coronary artery is more frequently involed,in which a large number of coronary thrombosis can be observed.The recurrence rate can be high.A concurrent platelet-lowering therapy is recommended.