免疫性血小板减少性紫癜合并急性心肌梗死的临床特征及相关文献复习

A case report and related literature review about thecharacteristics of acute myocardial infarction combined with idiopathic thrombocytopenia purpura

目的：探讨免疫性血小板减少性紫癜（ immune thrombocytopenic purpura， ITP）合并急性心肌梗死（ acute myocardial infarction， AMI）病例的临床特征、发病机制、预防及治疗方法。方法回顾性总结1例在ITP治疗过程中发生两次非ST段抬高性心肌梗死患者的临床特征，结合该例患者在该院的诊治经历并复习相关文献，总结分析其临床特征、发病机制、预防及治疗方法。结果迄今为止，文献报道ITP合并AMI患者共11例（包括本例）均为慢性型ITP患者，平均年龄62．64岁，男女比例为6∶5。其中9例合并一个或多个冠心病危险因素。结论 ITP患者发生AMI可能存在特殊机制，与内皮损伤及微循环障碍相关，也与ITP治疗过程相关。因此，对于合并多种冠心病危险因素的ITP患者，短时间快速升高血小板需谨慎。对于大面积STEMI无ITP所致出血征象，行急诊冠状动脉造影及术后抗血小板治疗是安全的。

Objective To investigate the clinical features, pathogenesis, prevention and treatment of acute myocardial infarction （ AMI ） combined with immune thrombocytopenic purpura （ ITP） .Methods We reported a case of an old man who suffered acute myocardial infarction twice during the treatment of ITP and reviewed data available in the literature and discussed the clinical characteristics, pathogenesis, prevention and treatment.Results Only 11 cases reports of AMI with ITP are available in the literature （ including this case） .All of ITPs were chronic with an average age of 62.64, Male/Female ratio was 6∶5.Among them, 9 patients had one or more risk factors for coronary heart disease.Conclusion TP patients with AMI may exist special mechanism： beside endothelial injury and microcirculation, we should considered the process of ITP treatment.However, careful attention must be paid for a rapid rise in the plateletcount, which may induce myocardial infarction or stroke, particularly in the elderly patients and in patients withcoronary risk factors.For patients with large area STEMI and no signs of bleeding caused by ITP, emergency coronary angiography and postoperative antiplatelet therapy are all safe.