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目的:探讨大动脉炎累及冠状动脉(冠脉)的临床特点、治疗及潜在的诊治难点。方法:回顾性分析我院1998-10～2011-12年住院的连续580例大动脉炎患者中,经冠脉造影证实冠脉病变狭窄大于50%的病例,对其临床特点、治疗及随访情况进行总结。结果:大动脉炎累及冠脉共43例,男性7例,女性36例,占同期住院大动脉炎患者的7.4%(43/580);心脏症状发作年龄15～64(41.0±13.2)岁。40例患者有典型心绞痛发作病史,其他主要症状包括外周血管杂音、无脉症和高血压。心电图示病理性Q波16例,ST-T缺血性改变33例,超声心动图示左室壁节段性运动异常10例,血沉升高27例。大动脉炎最常累及冠脉开口及近端,血管造影能明确诊断。1例冠脉造影时猝死,9例行血管内介入治疗,13例行冠脉旁路移植术。平均随访(5.8±3.3)年,死亡8例。结论:大动脉炎可累及冠状动脉,易导致心血管事件,严重病变应尽早行血运重建。
Objective: To investigate the clinical features, treatment and potential diagnosis and treatment of aortic arteritis involving the coronary artery (coronary artery). Methods: A retrospective analysis of our hospital from 1998 to 2011-2012 hospitalized 580 consecutive patients with arteritis, coronary angiography confirmed coronary stenosis greater than 50% of the cases, its clinical features, treatment and follow-up were carried out to sum up. Results: There were 43 cases of aortocorneal involvement in coronary arteries, including 7 males and 36 females, accounting for 7.4% (43/580) of the patients with aortic arteritis in the same period. The onset of heart symptoms was 15-64 years old (41.0 ± 13.2 years). Forty patients had a history of typical angina pectoris and other major symptoms included peripheral vascular murmur, pulselessness and hypertension. Electrocardiogram showed pathological Q wave in 16 cases, ST-T ischemic change in 33 cases, echocardiography showed segmental left ventricular wall motion abnormalities in 10 cases, elevated erythrocyte sedimentation rate in 27 cases. Aortitis most often involves the coronary ostia and proximal, angiography can confirm the diagnosis. One patient died of sudden coronary angiography, 9 received endovascular intervention, and 13 received coronary artery bypass grafting. The average follow-up (5.8 ± 3.3) years, 8 patients died. Conclusion: Arteriitis can affect the coronary arteries, easily lead to cardiovascular events, severe disease should be revascularized as soon as possible.