多发性大动脉炎累及冠状动脉的临床特点分析

Clinical features of Takayasu＇s arteritis complicated with coronary artery lesions

目的 研究多发性大动脉炎（TA）累及冠状动脉的临床特点。方法 本研究采用回顾性病例分析的方法，连续入选2003年7月至2015年6月于首都医科大学附属北京安贞医院住院治疗的474例TA患者的临床资料，筛选明确合并冠状动脉受累者62例作为观察组。选取同期住院的普通冠状动脉粥样硬化性心脏病患者124例为对照组。记录并分析患者的临床资料、动态红细胞沉降率（ESR）和C反应蛋白（CRP）指标以及冠状动脉病变特点。结果 观察组中女性患者较多，合并高脂血症病史、糖尿病病史、吸烟史的患者较少，ESR＞20 mm/1 h及CRP＞15 mg/L的患者较多，与对照组比较差异均有统计学意义［67.7%（42/62）比23.6%（28/124）、17.7%（11/62）比41.9%（52/124）、3.2%（2/62）比26.6%（33/124）、4.8%（3/62）比41.1%（51/124）、35.5%（22/62）比3.2%（4/124）、46.7%（29/62）比16.9%（21/124）］（均P＜0.05）。2组患者各心血管临床症状差异均无统计学意义（均P＞0.05）。观察组患者除心血管症状外的伴随症状以头痛及四肢疼痛［66.1%（41/62）］、乏力［58.1%（36/62）］、高血压［56.1%（35/62）］为多见。观察组中共发现142处冠状动脉病变（单支狭窄大于50%），对照组中共发现180处。观察组左主干病变及冠状动脉开口处受累比例明显多于对照组［8.5%（12/142）比3.3%（6/180）、40.1%（57/142）比7.2%（13/180）］（P＜0.01）；而冠状动脉近段和中段受累比例明显少于对照组［18.3%（26/142）比32.8%（59/180）、21.1%（30/142）比35.6%（64/180）］。结论 TA累及冠状动脉多见于女性，合并的心血管危险因素较少，血管病变更多累及患者的左主干及冠状动脉开口处。

Objective To analyze clinical features of Takayasu′s arteritis（TA） patients complicated with coronary artery lesions. Methods Four hundreds and seventy-four TA patients who were admitted in Beijing Anzhen Hospital, Capital Medical University from July 2003 to June 2015 were retrospectively analyzed; 62 patients with coronary artery involvement were selected as observation group. One hundred and twenty-four patients with coronary atherosclerotic heart disease were selected as control group. Clinical data, erythrocyte sedimentation tate（ESR）, C-reactive protein（CRP） and features of coronary artery lesions were analyzed. Results There were more female patients in observation group; there were less patients with hyperlipemia history, diabetes history, smoking and more patients with ESR〉20 mm/1 h and CRP〉15 mg/L than those in control group[67.7%（42/62） vs 23.6%（28/124）, 17.7%（11/62） vs 41.9%（52/124）, 3.2%（2/62） vs 26.6%（33/124）, 4.8%（3/62） vs 41.1%（51/124）, 35.5%（22/62） vs 3.2%（4/124）, 46.7%（29/62） vs 16.9%（21/124）]; the differences were significant（P〈0.05）. Cardiovascular symptoms had no significant differences between groups（P〉0.05）. Headache and pain of limbs[66.1%（41/62）], hypodynamia[58.1%（36/62）] and hypertension[56.1%（35/62）] were common symptoms in patients with TA involving coronary artery. Left main coronary and coronary ostium involving rates in observation group were significantly higher than those in control group[8.5%（12/142） vs 3.3%（6/180）, 40.1%（57/142） vs 7.2%（13/180）]（P〈0.01）; proximal coronary artery and middle coronary artery involving rates in observation group were significantly lower than those in control group[18.3%（26/142） vs 32.8%（59/180）, 21.1%（30/142） vs 35.6%（64/180）]（P〈0.05）. Conclusion Takayasu arteritis complicated with coronary artery lesions is more common in female, left main coronary artery and coronary ostium.