骨髓增殖性肿瘤合并急性心肌梗死临床分析

Clinical characteristics of myeloproliferative neoplasms complicated with acute myocardial infarction

目的分析骨髓增殖性肿瘤(MPN)合并急性心肌梗死(AMI)患者的临床特征。方法选取2007年4月至2017年5月首都医科大学附属北京安贞医院收治MPN合并AMI患者22例,其中真性红细胞增多症(PV)合并AMI 6例,原发性血小板增多症(ET)合并AMI 16例;分析2组患者的一般资料和血常规、心电图、冠状动脉造影、心脏彩色多普勒超声等检查结果以及治疗和随访情况。结果 MPN合并AMI患者22例,8例(36.4%)患者AMI于MPN诊断后发生,14例(63.6%)患者AMI与MPN同时诊断;ET合并AMI组ST段抬高型心肌梗死13例、非ST段抬高型心肌梗死2例、另外1例心肌梗死类型不详,PV合并AMI组ST段抬高型心肌梗死5例、1例心肌梗死类型不详;冠状动脉造影检查ET合并AMI组单支病变9例、≥2支病变7例,PV合并AMI组单支病变2例、≥2支病变4例;21例行冠状动脉血运重建治疗并接受抗血小板药物治疗,9例于术前已接受降细胞治疗、5例于术后接受降细胞治疗;随访期间3例于术后1个月再发冠状动脉病变,均为血运重建术前未强化降细胞治疗者,1例未行血运重建治疗患者1年后再发AMI。结论 AMI患者全血细胞计数异常时需警惕MPN的可能,MPN合并AMI以60岁以下男性、ET患者多见,女性发病年龄早于普通冠状动脉粥样硬化性心脏病患者,临床表现无特异性,治疗应注重降细胞、抗血小板及冠状动脉血运重建的综合治疗。

Objective To analyze the clinical characteristics of myeloproliferative neoplasms （MPN） complicated with acute myocardial infarction（AMI）. Methods Twenty-two patients suffering from AMI complicated with MPN, including 6 patients with polycythemia vera（PV） and 16 patients with essential thrombocythemia（ ET）, were enrolled from April 2007 to May 2017 in Beijing Anzhen Hospital, Capital Medical University. Results of routine blood test, electrocardiography, coronary angiography, color Doppler ultrasonography, therapeutic plans and outcomes were analyzed. Results In 22 patients with AMI complicated with MPN, 14 cases（63.6% ） were diagnosed of AMI and MPN concurrently; 8 patients （36. 4% ） developed AMI after the diagnosis of MPN. There were 13 cases of ET with ST-segment elevation myocardial infarction and 2 cases of ET with non-ST-segment elevation myocardial infarction; the type of AMI in 1 patient with ET was unclear. There were 5 cases of PV with ST-segment elevation myocardial infarction and 1 case of PV with unclear type myocardial infarction. Coronary angiography showed 9 cases of single vessel lesion and 7 cases of multiple vessel lesions in ET with AMI; there were 2 cases of single vessel lesion and 4 cases of multiple vessel lesions in PV with AMI. Twenty-one patients had coronary revascuIarization and anti-platelet therapy. Nine patients had cytoreductive therapy before revascularization; 5 patients received cytoreductive therapy＇ after revascularization. Three patients who did not have cytoreductive therapy before revascularization had recurrent coronary disease in 3 months after operation. One patient without coronary revascularization had recurrent AMI in 1 year. Conclusions AMI patients with abnormal complete blood count have a high possibility of MPN. AMI with MPN is mostly seen in male patients under 60 years old. The onset age of MPN is younger than that of coronary heart disease in female patients. MPN is lack of characteristic symptoms; clinical treatments mainly include cytoreductive, antiplatelet therapy and coronary revascularization.