西罗莫司洗脱支架相关间质性肺炎

Sirolimus-eluting stents related interstitial pneumonia

1例54岁男性患者因急性心肌梗死先后2次行经皮冠状动脉介入治疗（PCI）。第1次PCI植入西罗莫司洗脱支架5枚，术后5周患者出现胸闷、憋气症状。考虑为劳力型心绞痛。于出现症状后第5天行第2次PCI，植入西罗莫司洗脱支架2枚，术后第4天患者再次出现胸闷症状并逐渐加重。按心功能不全治疗2 d，症状无明显缓解。术后第5天实验室检查示白细胞计数15.5×109/L，中性粒细胞0.90，给予头孢替安抗感染治疗，患者症状仍未缓解，且出现发热（最高为38.5 ℃）。术后第9天胸部CT示双肺间质性肺炎，考虑为西罗莫司洗脱支架所致。给予亚胺培南、奥司他韦和甲泼尼龙治疗，2周后患者症状明显缓解，胸部CT示双肺间质性炎症好转。

A 54-year-old male patient underwent percutaneous coronary intervention（PCI） twice for acute myocardial infarction. Five sirolimus-eluting stents were implanted in the first PCI and the patient developed chest distress and short of breath 5 weeks after the operation. Exertional angina was considered. The second PCI with 2 sirolimus-eluting stents implantation was conducted on day 5 after the symptoms appeared. Chest distress recurred on day 4 after the second operation and gradually aggravated. The chest distress did not relieve after 2 days of treatments of cardiac insufficiency. Laboratory tests on day 5 after the second operation showed a white blood cell count of 15.5×109/L and neutrophils of 0.90. Anti-infection therapy with cefotiam was given but the symptom did not improved and fever appeared （up to 38.5 ℃）. On day 9 after the second operation, chest CT examination showed interstitial pneumonia in bilateral lungs, which were considered to be induced by sirolimus-eluting stents. Methylprednisolone, imipenem, and oseltamivir were given. Two weeks later, the patient′s symptoms improved markedly and chest CT examination showed improvement of interstitial pneumonia in bilateral lungs.