Norris S, Johnson C S, Haywood L J
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033.
J Natl Med Assoc. 1991 Mar;83(3):209-13.
The possibility that myocardial ischemia may be associated with chest pain during painful crises was evaluated prospectively in 20 patients (11 women and nine men) with sickle cell disease (19 SS, 1 S beta + thalassemia). Sixteen of 20 (80%) had abnormal ECGs, 7 (35%) had transient ST-T wave changes, and 3 (15%) had persistent ST-T wave changes, both consistent with ischemia; 6 (30%) had nonspecific ST-T changes, and 4 (20%) had normal tracings. Serum enzymes (CK, SGOT, LDH) were abnormal in 16 of 19 (84%); 1 had CK-MB detected, (5%) and 1 had LDH1 to LDH2 reversal. All 10 Tc-99m pyrophosphate scans performed were negative; 4 of 6 (66%) thallium-201 scans had focal defects, and 5 of 8 (63%) radionuclide angiograms (MUGAs) had focal wall motion abnormalities. Three of 8 (38%) MUGAs showed cardiac dilation, diffuse hypokinesis, and reduced ejection fractions. Thus, myocardial damage may be a potentially serious complication of patients with sickle cell anemia who present with chest pain during painful crises. Studies are indicated to define the significance and pathophysiology of these observations.
对20例镰状细胞病患者（11名女性和9名男性，其中19例为SS型，1例为Sβ+地中海贫血）进行前瞻性评估，以确定疼痛发作期间心肌缺血与胸痛之间是否存在关联。20例患者中有16例（80%）心电图异常，7例（35%）出现短暂性ST-T波改变，3例（15%）出现持续性ST-T波改变，均符合心肌缺血表现；6例（30%）出现非特异性ST-T改变，4例（20%）心电图正常。19例患者中有16例（84%）血清酶（CK、SGOT、LDH）异常；1例检测到CK-MB（5%），1例出现LDH1至LDH2倒置。所有10次锝-99m焦磷酸盐扫描结果均为阴性；6例铊-201扫描中有4例（66%）出现局灶性缺损，8例放射性核素血管造影（MUGA）中有5例（63%）出现局灶性室壁运动异常。8例MUGA中有3例（38%）显示心脏扩大、弥漫性运动减弱和射血分数降低。因此，对于镰状细胞贫血患者，在疼痛发作期间出现胸痛时，心肌损伤可能是一种潜在的严重并发症。有必要开展研究以明确这些观察结果的意义和病理生理学机制。
