Lanore J J, Piette J C, Chapelon C, Giraud T, Wechsler B, Blétry O, Vinceneux P, Gourgon R, Godeau P
Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Ann Med Interne (Paris). 1990;141(6):519-25.
Between 1974 and 1988, 7 myocardial infarctions occurred in 6 (4 men, 2 women) out of 400 systemic lupus erythematosus patients. Their ages at the onset of lupus ranged from 13 to 44 years (m = 26). Four had renal involvement. Control of lupus in all 6 patients required high-dose steroids (at least 1 mg/kg/d of prednisone). Myocardial infarction occurred 4 to 19 years after the onset of lupus (m = 13). One patient died of cardiogenic shock. When the infarction occurred, only one patient was undergoing a lupus flare, while the disease was quiescent or slightly active in the 5 others. One patient had no risk factors for atheroma but had been taking steroids for 10 years. Among the other 4, one had hypertension, another had hyperlipidemia and 3 were smokers; they had been on steroids for 2, 4, 11 and 13 years. Coronary angiogram showed occlusion in all 4, but atheroma in only 2 patients. Lupus anticoagulant was present in 3 of these 4 patients. The mechanisms responsible for coronary occlusion in lupus patients are probably complex and interwoven. In addition to "classical" factors (i.e., vasculitis or steroid-induced atheroma), other factors, such as antiphospholipid antibodies and/or smoking, may play an important thrombogenic role.
1974年至1988年间，400例系统性红斑狼疮患者中有6例（4名男性，2名女性）发生了7次心肌梗死。他们患狼疮时的年龄在13岁至44岁之间（平均26岁）。4例有肾脏受累。所有6例患者的狼疮控制都需要大剂量类固醇（至少1毫克/千克/天的泼尼松）。心肌梗死发生在狼疮发病后4至19年（平均13年）。1例患者死于心源性休克。梗死发生时，只有1例患者处于狼疮活动期，而其他5例患者的病情处于静止或轻度活动状态。1例患者没有动脉粥样硬化的危险因素，但已服用类固醇10年。在其他4例中，1例有高血压，另1例有高脂血症，3例吸烟；他们服用类固醇的时间分别为2年、4年、11年和13年。冠状动脉造影显示所有4例均有血管闭塞，但只有2例有动脉粥样硬化。这4例患者中有3例存在狼疮抗凝物。狼疮患者冠状动脉闭塞的机制可能很复杂且相互交织。除了“经典”因素（即血管炎或类固醇诱导的动脉粥样硬化）外，其他因素，如抗磷脂抗体和/或吸烟，可能在血栓形成中起重要作用。
