单纯累及冠状动脉的大动脉炎临床特点分析

Clinical characteristics of isolated coronary ostial stenosis as the sole arterial involvement in Takayasu arteritis

目的探讨单纯累及冠状动脉的大动脉炎(Takayasu arteritis)的临床特点。方法回顾性分析中国医学科学院北京协和医院2013年1月至2015年3月收治的3例单纯累及冠状动脉的大动脉炎病例的临床资料,并结合文献复习相关的研究进展。结果 3例患者均为青中年女性,年龄分别为15岁、23岁和43岁。3例患者均表现为活动后胸痛或胸闷,心电图可见广泛导联ST段压低;肌钙蛋白Ⅰ轻度升高。查体双上肢血压均对称,冠状动脉造影均发现冠状动脉开口重度狭窄。外周动脉超声均未见明显狭窄,但均有动脉壁轻度增厚表现。结论青中年女性发生心肌梗死要警惕大动脉炎的可能,个别患者可单纯累及冠状动脉,临床以心绞痛、心肌梗死为大动脉炎的首发表现;磁共振血管造影、^(18)F-FDG PET/CT是早期诊断大动脉炎的有效方法;大动脉炎累及冠状动脉多为开口病变,临床治疗决策困难。

Objective To explore the clinical features of the sole coronary involvement in Takayasu arteritis（TA）. Method The clinical data of 3 TA patients with sole coronary involvement admitted to Peking Union Medical College Hospital were retrospectively analyzed and the review of recent literatures was performed. Result Three patients were all female, aged 15, 23 and 43 respectively. They all suffered from chest pain during exercise, with electrocardiogram presented depression of ST segment in diffused leads. TroponinⅠwere slightly elevated. They did not present significant difference in systolic pressure in the arms. Coronary angiography revealed severe ostial stenosis of coronary artery the slightly increased thickness of the artery wall. Conclusion TA was an uncommon cause of myocardial infarction in female adolescence, and rare cases involved coronary artery as the sole arterial involvement, which presented with angina pectoris or myocardial infarction as its first manifestation; MRA and ^（18）F-FDG PET/CT were useful for early diagnosis of TA. Stenosis of the ostia of coronary artery was the most frequent finding of the coronary vasculature in patients with TA, which made the clinical strategy difficult.