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成人孤立性冠状动脉炎:来自中国的单中心经验。

Isolated Coronary Arteritis in Adults: a Single-Center Experience from China.

机构信息

Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.

Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

出版信息

J Cardiovasc Transl Res. 2023 Oct;16(5):1184-1193. doi: 10.1007/s12265-023-10388-4. Epub 2023 Apr 25.

Abstract

Isolated coronary arteritis (ICA) is an extremely rare and life-threatening vasculitis with only a limited number of reports in the literature. We retrospectively reviewed the clinical data of 10 ICA patients in our center from 2012 to 2022 and compared them with patients with Takayasu arteritis who presented with coronary arteritis initially (TAK-CA patients). We found that ICA predominantly affected women and most commonly involved the ostium and the proximal segment of the coronary arteries, causing mainly stenotic lesions. The C-reactive protein and erythrocyte sedimentation rate were grossly normal and significantly lower than those of TAK-CA patients (p = 0.027, p = 0.009, respectively). Intravascular ultrasound imaging showed superiority in differentiating coronary vasculitis from atherosclerosis. Restenosis of the coronary arteries occurred rapidly if not treated promptly and appropriately. Systemic glucocorticoid combined with immunosuppressive agents, especially cyclophosphamide, was a promising strategy for treating ICA.

摘要

孤立性冠状动脉炎(ICA)是一种极其罕见且危及生命的血管炎,文献中仅有有限数量的报道。我们回顾性分析了 2012 年至 2022 年我院 10 例 ICA 患者的临床资料,并与以冠状动脉炎为首发表现的 Takayasu 动脉炎患者(TAK-CA 患者)进行了比较。我们发现 ICA 主要影响女性,最常累及冠状动脉口和近段,主要引起狭窄性病变。C 反应蛋白和红细胞沉降率明显正常,明显低于 TAK-CA 患者(p=0.027,p=0.009)。血管内超声成像在鉴别冠状动脉炎与动脉粥样硬化方面具有优势。如果不及时、适当治疗,冠状动脉会迅速发生再狭窄。全身糖皮质激素联合免疫抑制剂,特别是环磷酰胺,是治疗 ICA 的一种有前途的策略。

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