白塞氏病累及冠状动脉患者六例临床特点分析

The Imaging and Clinical Feature Analysis for Behcet's Disease With Coronary Artery Involvement in 6 Patients

目的:探讨累及冠状动脉的白塞氏病患者的影像学特点,以期提高临床诊治。方法:分析1999-08至2016-11在阜外医院诊治的6例白塞氏病冠状动脉受累患者的临床特点。采用冠状动脉造影和(或)冠状动脉增强计算机体层摄影术血管造影(CTA)诊断。6例中5例患者行冠状动脉造影检查,5例行冠状动脉CTA检查。结果:6例白塞氏病患者累及冠状动脉首次均以突发心包填塞、心肌梗死或心原性休克就诊,影像学表现为冠状动脉狭窄、闭塞及假性动脉瘤形成。累及前降支近中段3例,回旋支远段1例,右冠状动脉中段2例,均伴有大量心包积液。治疗方面:3例患者冠状动脉假性动脉瘤保守治疗(以为占位病变开胸探查手术1例),其中1例失访,2例长期正常生活;3例患者发病后行冠状动脉支架置入术,术后效果不佳。结论:累及冠状动脉的白塞氏病患者易形成假性动脉瘤,通过冠状动脉造影和(或)冠状动脉CTA有助于诊断。术前明确病因诊断对临床治疗方法选择有重要意义。

Objective： To explore the imaging and clinical features of Behcet＇s disease with coronary artery involvement in order to improve the diagnosis and treatment in clinical practice. Methods： A total of 6 Behcet＇s disease patients with coronary involvement diagnosed and treated in our hospital from 1999-08 to 2016-11 were analyzed. Coronary angiography （CAG） and coronary CTA were performed for diagnosis. There were 5 cases received CAG and 5 cases received CTA examinations. Results： All 6 patients had the first clinical visit by sudden pericardial tapenade, myocardial infarction or cardiac shock. For diagnosis： the imaging presentation included coronary stenosis, occlusion and pseudo aneurysm formation. 3 patients had anterior descending artery involvement, 1 had the far-end of left circumflex involvement and 2 had the middle segment of right coronary involvement; all patients were combining large amount of pericardial effusion. For treatment： there were 3 patients with aneurysm received conservative treatment （1 case had open thoracic exploration）, 1/3 lost contact and 2 having long-term normal life; 3 patients received coronary stent implantation without optimal effect. Conclusion： The patients of Behcet＇s disease with coronary involvement may easily form pseudo aneurysm; CAG/CTA has been helpful for diagnosis. Clear pre-operative diagnosis of etiology is important for treatment.