原发性血小板增多症患者经皮冠状动脉介入治疗随访结果分析

Analysis of follow-up results after percutaneous coronary intervention in patients with primary thrombocythemia

目的回顾性分析原发性血小板增多症患者行经皮冠状动脉介入治疗(PCI)的特点、治疗及预后。方法收集2010年1月至2017年7月北京协和医院心内科收治的9例原发性血小板增多症患者因合并有冠心病后行PCI的临床资料,并对PCI数据、术后药物治疗和长期随访结果进行回顾性分析。结果 9例患者中男性5例,女性4例,平均年龄(60.9±14.3)岁;急性心肌梗死患者3例,陈旧性心肌梗死患者2例,不稳定型心绞痛患者2例,稳定性冠心病患者2例;单支病变患者4例,多支病变5例;所有患者均置入药物洗脱支架,PCI术前血小板计数(596±233)×109/L,其中4例住院期间诊断原发性血小板增多症患者血小板计数为(803±105)×109/L;所有患者术后均接受阿司匹林联合氯吡格雷的双联抗血小板治疗,8例患者同时长期服用羟基脲,平均随访(53.2±26.9)个月,术后随访期间血小板计数(485±133)×109/L,随访期间无不良心血管事件发生,仅有1例患者因胃溃疡出现消化道出血事件。结论对于原发性血小板增多症合并冠心病行PCI患者,给予长期双联抗血小板治疗并合用羟基脲是安全有效的。

Objective To analyze the characteristics, treatment and prognosis during follow-up in patients with essential thrombocythemia（ET）after percutaneous coronary intervention（PCI）. Methods A total of 9 patients with ET who had CAD and treated with PCI in our hospital from 2010-01 to 2017-07 were retrospectively studied. The basic clinical information with clinical data,data of coronary intervention,application of anti-platelet and platelet reducing drugs,and the results of long-term follow-up were recorded in all patients. Results There were 5 male and 4 female with a mean age of （60.9 ± 14.3） years The 9 patients included 3 cases of acute myocardial infaction（MI）,3 cases of old MI,2 cases of unstable angina and 2 cases stable angina. Coronary angiography revealed that there were 4 cases with single vessle involved and 5 cases with two-three vessles involved. All the patients were implante with drug-eluting stents. The mean platelet counts of the patients at admission were（596±233）×109/L. In 4 patients, ET was diagnosed during current hospitalization and their mean platelet counts were（803±105）×109/L. All patients received dual anti-platelet drugs after PCI and 8 patients had hydroxyurea during follow-up. During the follow-up of （53.2±26.9） months,no cardiovascular events occurred. One case of gastrointestinal bleeding occurred during the follow-up due to gastric ulcer. Conclusions Application of platelet reducing therapy with dual anti-platelet drugs in ET patients after PCI is eff ective and safe.