对比剂过敏致Ⅱ型Kounis综合征1例临床分析

Clinical Analysis of TypeⅡKounis Syndrome Induced by Contrast Agent Allergy:A Case Report

目的分析对比剂过敏致Kounis综合征的临床特点及诊治方案。方法分析医院收治的1例接受冠状动脉CT血管造影(CTA)检查,并在注射对比剂碘普罗胺注射液后出现胸痛、全身过敏反应、意识模糊、心电图多导联ST段抬高、肌钙蛋白水平升高的病例,结合文献总结其临床特点及诊治方案。结果根据Kounis综合征诊断标准及患者的临床表现判断其发生了Ⅱ型Kounis综合征,考虑为对比剂所致不良反应,其发生机制可能与对比剂造成的过敏性冠状动脉血管痉挛有关。溶栓并给予阿司匹林、替格瑞洛、瑞舒伐他汀、地尔硫、培哚普利、低分子肝素等药物治疗后,患者病情缓解,于入院1周时出院,出院1个月未复发。结论使用碘对比剂后出现过敏反应伴急性心肌缺血改变时,需考虑Kounis综合征,应根据其类型给予及时、规范治疗,避免给患者造成永久或重大伤害。

Objective To analyze the clinical characteristics and treatment regimen of Kounis syndrome induced by contrast agent allergy.Methods A patient admitted to the hospital was given the CT angiography(CTA)of coronary artery,and chest pain,systemic allergic reaction,confusion of consciousness,electrocardiogram(ECG)multi-lead ST segment elevation and increased level of troponin occurred after the treatment of contrast agent Iopromide Injection.The clinical characteristics,diagnosis and treatment regimen of the above adverse reaction were summarized based on studies.Results According to the diagnostic criteria of Kounis syndrome and the patient's clinical manifestations,it was determined that the typeⅡKounis syndrome occurred,which was considered an adverse reaction induced by contrast agent,and its mechanism might be related to the allergic coronary vasospasm induced by contrast agent.After thrombolysis,aspirin,ticagrelor,rosuvastatin,diltiazem,perindopril and low-molecular-weight heparin treatment,the patient's condition improved,and he discharged at the first week of admission,and there was no recurrence after one month of discharge.Conclusion When allergic reactions accompanied with acute myocardial ischemia occur after the use of iodine contrast agent,we should consider Kounis syndrome,provide timely and standardized treatment based on its type to avoid inducing permanent or serious harm to patients.