原发性血小板增多症合并冠状动脉粥样硬化性心脏病患者的临床特征分析

Analysis of clinical features of patients with essential thrombocythemia complicated with coronary heart disease

目的分析原发性血小板增多症合并冠状动脉粥样硬化性心脏病(以下简称冠心病)患者的临床特征。方法收集2014年1月—2018年6月于郑州大学第一附属医院住院治疗的21例原发性血小板增多症合并冠心病患者的临床资料,分析其临床特征。结果21例患者中,男性6例,女性15例,平均年龄(60.8±10.7)岁;合并心血管危险因素者17例;JAK2V617F基因突变阳性者16例;既往有血栓病史者6例;入院平均血小板计数为(880±360)×109/L;急性心肌梗死起病者7例,不稳定性心绞痛者9例,稳定型冠心病者5例;病变累及左前降支者17例;9例患者行支架置入治疗,共置入支架12枚;16例患者接受了阿司匹林联合氯吡格雷或替格瑞洛的双联抗血小板治疗,5例患者接受阿司匹林单抗治疗;20例患者院外长期口服羟基脲治疗,1例患者行干扰素治疗;平均随访时间(27±17)个月,随访期间平均血小板计数(395±116)×109/L,较入院时下降(P<0.05)。1例患者于治疗后发生急性心力衰竭,1例患者发生消化道出血及脑梗死,1例患者发生消化道出血及脑出血,1例患者发生脑梗死,1例患者发生肺栓塞。结论原发性血小板增多症合并冠心病患者最常累及冠状动脉的左前降支,且起病表现以急性冠状动脉综合征者多见,心血管危险因素及JAK2V617F基因突变与其发病相关,临床上需注意预防脑血管并发症及出血事件。

Objective To analyze the clinical features of patients with essential thrombocytosis(ET)complicated with coronary heart disease(CHD).Methods Twenty-one patients with ET complicated with CHD who were treated in the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2018 were retrospectively studied.The basic clinical information was recorded in all patients.Results There were 6 male patients and 15 female patients and their mean age was(60.8±10.7)years.There were 17 patients with cardiovascular risk factors,16 patients with positive JAK2V617F gene mutation and 6 patients with previous history of thrombosis.The average platelet count for admission was(880±360)×109/L.The 21 patients included 7 cases of acute myocardial infarction,9 cases of unstable angina pectoris and 5 cases of stable coronary heart disease.Seventeen patients had left anterior descending artery involved.Nine patients underwent percutaneous coronary intervention operation and 12 stents were placed.Sixteen patients received double anti-platelet therapy with aspirin combined with clopidogrel or ticagrelor,and 5 patients only received aspirin.Twenty patients had received long-term treatment with hydroxyurea,and one patient received interferon therapy.The average followup time was(27±17)months.The mean platelet count(395±116)×109/L during the follow-up period was lower than that at admission(880±360)×109/L(P<0.05).In all of the patients,one patient developed acute heart failure after therapy,one patient suffered with gastrointestinal bleeding and cerebral infarction,one case of them had gastrointestinal bleeding and cerebral hemorrhage,while cerebral infarction occurred in one patient and one patient developed pulmonary embolism.Conclusion Left anterior descending artery is the most frequently involved coronary artery in ET patients with CHD,and acute coronary syndrome is the most common type of onset.Cardiovascular risk factors and JAK2V617F gene mutation are associated with this disease.The prevention of cerebrovascular complications and bleeding events should be emphasized.