原发性血小板增多症合并心肌梗死10例

Analysis of Essential Thrombocythemia Combining Myocardial Infarction in 10 Patients

目的：回顾性分析原发性血小板增多症患者合并心肌梗死特点、治疗及预后，为临床实践积累经验。方法：收集并回顾性分析2003-01至2015—07我院心内科收治的10例原发性血小板增多症合并心肌梗死患者的病例资料，包括一般资料、入院主诉、既往史、外周血血小板计数、超声心动图、冠状动脉造影、抗血小板药物、降血小板治疗、预后等情况。结果：10例患者中男性6例，女性4例，均为ST段抬高的心肌梗死。平均年龄（55.3±9．7）岁。急性心肌梗死7例，陈旧性心肌梗死3例。入院时血小板3例（500—599）×10^9／L、1例（600，699）×10^9／L、3例（700～799）×10^9／L、1例（800～899）×10^9／L、1例（900～999）×10^9／L、1例大于1000×10^9／L。超声心动图左心室射血分数≤50％5例、〉50％5例。冠状动脉造影示累及前降支9例，累及回旋支2例，累及右冠脉5例。所有患者术前接受双抗血小板药物治疗。4例患者术前服用羟基脲治疗20～30天，术后无心血管事件；6例患者术前未服羟基脲降血小板治疗，术后1例因发作心绞痛再入院，2例冠状动脉病变进展。结论：介入治疗前、后应用降血小板治疗可能有助于改善预后。

Objective： To analyze the characteristics, treatment and prognosis in patients with essential thrombocythemia （ET） combining myocardial infarction （MI）. Methods： A total of 10 patients with ET combining MI treated in our hospital from 2003-01 to 2015-07 were retrospectively studied. The basic clinical information with major admission complaints, previous history and peripheral platelet counts were recorded; echocardiograph, coronary angiography （CAG）, application of anti-platelet drugs and platelet reductive therapy with the prognosis were recorded in all patients. Results： There were 6 male and 4 female with a mean age of （55.3 ±9.7） years, 7 patients with AMI and 3 with old MI. The platelet counts at admission were （500-599） ×10^9/L in 3 patients, （600-699）×10^9/L in 1 patient, （700-799） ×10^9/L in 3 patients, （800- 899） ×10^9/L in 1 patients, （900-999） ×10^9/L in 1 patient and more than 1000 ×10^9/L in 1 patient. Echocardiograph indicated that 5 patient had LVEF ≤50% and 5 had LVEF〉50%. CAG revealed that there were 9 cases with left anterior descending involved, 2 with circumflex involved and 5 with fight coronary involved. All patients received dual anti-platelet drugs before operation, 4 had hydroxyurea for （20-30） days before operation and no post-operative cardiovascular events occurred; 6 patients without hydroxyurea medication and 1 of them was re-hospitalized for angina pectoris and 2 had progressed coronary lesions. Conclusion： Application of platelet reductive therapy at before and after interventional treatment may improve the prognosis in patients with ET combining MI.