15例银屑病合并冠心病患者的临床及预后特点

The Clinical Characteristics and Prognosis of 15 Patients with Psoriasis and Coronary Heart Disease

目的总结银屑病合并冠心病的临床特点及预后情况。方法通过回顾性分析15例明确诊断为银屑病,并经冠状动脉造影确诊为初发冠心病的患者,分析其传统冠心病危险因素、第一次心血管病事件发作时的情况、冠状动脉病变特点以及心血管病事件和银屑病病情随访结果。结果银屑病患者初发冠心病年龄为55.13±10.90岁,传统冠心病危险因素为3.20±1.01个/例。15例患者中以急性冠状动脉综合征发病的有11例(73.33%),其中5例为急性ST段抬高型心肌梗死,3例为急性非ST段抬高型心肌梗死,3例为不稳定型心绞痛。冠状动脉造影结果显示,单支病变4例(26.67%),双支病变3例(20.0%),三支病变6例(40.0%),左主干病变2例(13.33%),其中左主干+三支病变1例(6.67%);有11例(73.33%)为弥漫性病变,其中2例(13.33%)为弥漫性病变伴严重钙化。15例患者中有11例行经皮冠状动脉介入(PCI)治疗。平均随访16.33±8.65个月,3例患者随访期间有再发心绞痛,其中2例再次行PCI治疗。15例患者最后一次随访时的PASI评分较入院时明显降低(8.98±1.34比12.91±1.10,P=0.01)。结论银屑病合并冠心病患者以急性起病多,冠状动脉病变程度重,随访期间心血管事件发生率较高。他汀类药物的应用可能对银屑病本身的病情也有着一定程度的改善作用。

Aim To summarize the clinical characteristics and prognosis of psoriasis complicated with coronary heart disease（CHD）. Methods A retrospective analysis was performed on 15 patients diagnosed with psoriasis and primary CHD by coronary angiography. The traditional CHD risk factors,the situation of the first cardiovascular event,the characteristics of coronary artery lesion and follow-up results of cardiovascular disease events and psoriasis were analyzed. Results The age of onset CHD in patients with psoriasis was 55. 13 ± 10. 90 years old,and traditional risk factors for CHD were 3. 20 ± 1. 01 average per case. There were 11 cases（73. 33%） of acute coronary syndrome in 15 cases,including 5 cases of acute ST-segment elevation myocardial infarction,3 cases of acute non ST-segment elevation myocardial infarction,3 cases of unstable angina pectoris. Coronary angiography showed single vessel lesion in 4 cases（26.67%）,double vessel lesion in 3 cases（20. 0%） and three vessel lesion in 6 cases（40. 0%）,left main coronary artery lesion in 2 cases（13. 33%）,left main coronary artery lesion plus three vessel lesion in 1 case（6. 67%）. 11 cases（73. 33%） were diffuse lesions,among them,2 cases（13. 33%） were diffuse lesion with severe calcification. Percutaneous coronary intervention（PCI） was administered in 11 patients. The average follow-up time was 16. 33 ± 8. 65 months,and 3 patients had recurrent angina,2 cases of them were treated with PCI again. Psoriasis area and severity index（PASI） score of 15 patients at the last follow-up was significantly lower than that at the admission（8. 98 ± 1. 34 vs 12.91 ± 1. 10,P = 0. 01）. Conclusions Patients with psoriasis and CHD are more acute onset. The degree of coronary artery lesion is heavy,and the incidence of cardiovascular events is higher during the follow-up period. The use of statins may also have a certain degree of improvement in the condition of psoriasis.