Ischemic heart disease in systemic lupus erythematosus in the young patient: report of six cases.
Ischemic heart disease in systemic lupus erythematosus in the young patient: report of six cases.
复制标题
年轻患者系统性红斑狼疮引起的缺血性心脏病：六例报告。
DOI：
10.1016/0002-9149(82)90528-8
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Miller,LM
中科院分区：
文献类型：
--
作者：
Homcy,CJ;Liberthson,RR;Fallon,JT;Gross,S;Miller,LM
为了阐明系统性红斑狼疮患者冠状动脉异常的临床特征，我们回顾了6名年龄在15岁至29岁之间被诊断为狼疮，并在35岁之前患有缺血性心脏病的患者的数据。两名患者在尸检中被诊断为冠脉炎。在第三个患者中，冠状动脉解剖结构的改变与血管造影的改善在时间上与类固醇治疗的开始有关。另外三名患者有严重的弥漫性动脉粥样硬化性冠状动脉疾病，其中两名在尸检中被发现。在第三例患者中，病程强烈提示冠状动脉粥样硬化，最终进行了冠状动脉旁路移植术以缓解心绞痛。综上所述，临床上重要的壁外冠状动脉炎和动脉粥样硬化都发生在年轻的狼疮患者中，尽管很少发生。冠状动脉疾病可合并或不合并活动性心外狼疮表现。对于心绞痛和怀疑有冠脉炎的患者，短期类固醇治疗和后续血管造影术值得考虑。当后续血管造影术显示冠状动脉解剖结构稳定时，治疗取决于患者的症状，而不考虑狼疮的既往病史，如果有指征，可以安全地进行心脏手术以缓解症状。
To clarify the clinical spectrum of coronary arterial abnormalities in systemic lupus erythematosus, the data were reviewed on six patients who had a diagnosis of lupus at ages 15 to 29 years and who had ischemie heart disease before age 35. Two patients had coronary arteritis diagnosed on postmortem examination. In a third patient alterations in coronary arterial anatomy occurred with angiographic improvement temporally related to the initiation of steroid therapy. The other three patients had severe diffuse atherosclerotic coronary disease that was identified in two at postmortem examination. In the third patient the course of the disease strongly suggested coronary atherosclerosis, and eventually coronary bypass grafting was performed for relief of angina, In summary, clinically important extramural coronary arteritis and atherosclerosis both occur, although rarely, in young patients with lupus. Coronary artery disease may occur with or without coexisting active extracardiac lupus manifestations. Short-term steroid therapy and follow-up angiography for those with angina and in whom coronary arteritis is suspected warrant consideration. When stable coronary arterial anatomy is demonstrated on follow-up angiography, management is determined by the patient's symptoms Irrespective of the prior history of lupus and, if indicated, cardiac surgery for symptomatic relief can be safely performed.