Martin C R, Johnson C S, Cobb C, Tatter D, Haywood L J
Department of Medicine, LAC+USC Medical Center 90033, USA.
J Natl Med Assoc. 1996 Jul;88(7):428-32.
Gross and microscopic findings consistent with acute (three patients) and healed (four patients) myocardial infarction were found in seven (9.7%) of 72 consecutive hearts from patients with sickle cell disease studied after autopsy between 1950 and 1982. Gross obstructive and atherosclerotic lesions were absent in all seven patients, while microthrombi were present in the arterioles of infarcted tissue in two patients. Pathophysiological mechanisms responsible for the infarction are unclear, but anemia, platelet thrombi, coronary vasospasm, and abnormal rheology related to sickle cells may all be important. Chest pain occurred clinically in six of the seven patients and ECG findings typical of infarction were found in two patients. One patient died suddenly. These findings suggest that ischemic heart disease may be present in a significant number of patients with sickle cell disease and should be considered in all patients who complain of chest pain, whether or not the patient is in crisis.
在1950年至1982年间对镰状细胞病患者进行尸检研究的连续72颗心脏中，有7颗（9.7%）发现了与急性心肌梗死（3例）和愈合性心肌梗死（4例）相符的大体和微观表现。所有7例患者均未发现明显的阻塞性和动脉粥样硬化病变，而2例患者梗死组织的小动脉中存在微血栓。导致梗死的病理生理机制尚不清楚，但贫血、血小板血栓、冠状动脉痉挛以及与镰状细胞相关的异常流变学可能都很重要。7例患者中有6例临床上出现胸痛，2例患者发现有典型梗死的心电图表现。1例患者突然死亡。这些发现表明，大量镰状细胞病患者可能存在缺血性心脏病，所有主诉胸痛的患者，无论是否处于危象期，都应考虑到这一点。
