Rossi C, Randi M L, Zerbinati P, Rinaldi V, Girolami A
Institute of Medical Semeiotics, Internal Medicine, University of Padua Medical School, Italy.
J Intern Med. 1998 Jul;244(1):49-53. doi: 10.1046/j.1365-2796.1998.00314.x.
The aim of this study is to report our experience on myocardial infarction (MI) in patients with essential thrombocythemia (ET) and polycythemia vera (PV).
Patients with PV and ET consecutively diagnosed and followed in authors' Department between 1 July 1986 and 30 June 1996.
Over the past 10 years we have followed 170 patients with ET and 149 with PV, diagnosed according to the Polycythemia Vera Study Group (PVSG) criteria. The patients were divided into 3 groups on the basis of the age at diagnosis (group A < 40, B 41-65, C > 65 years).
In all patients with PV phlebotomies and/or myelosuppressive therapy were used to keep haematocrit level lower than 45%. Hydroxyurea was given to patients with ET with a positive history for major vascular complications or with an extreme thrombocytosis. Aspirin therapy (ASA) (100 mg per day) was administered in patients with microvascular disturbances or previous thrombosis (in patients with PV also in the presence of atherosclerotic risk factors).
Frequency of MI in patients with ET and PV with and without ASA therapy.
9.4% of patients with ET and 11.4% of those with PV had MI. 17.6% of patients with PV were younger than 40 years at the moment of MI in contrast to 0% of those with ET. 75% of patients with ET and 70.6% of those with PV with MI had atherosclerotic risk factors such as smoking, hypertension, diabetes, dyslipidaemia. All patients with MI received ASA 100 mg daily after thrombosis and four of the ET group developed a transient ischaemic attack (TIA) afterwards. Four subjects with PV during the follow-up had TIAs and two peripheral arteriopathy in spite of ASA treatment.
MI is less common in patients with ET younger than 40 years than in older patients. Association of MI and cardiovascular risk factors is frequent in patients with ET and PV. A low dose of ASA could be able to reduce the number of coronary thrombosis without increasing bleeding complications in patients with elevated platelet count and common atherosclerotic risk factors. However, a larger population must be evaluated to confirm our hypothesis.
本研究旨在报告我们在原发性血小板增多症（ET）和真性红细胞增多症（PV）患者中治疗心肌梗死（MI）的经验。
1986年7月1日至1996年6月30日期间，作者所在科室对PV和ET患者进行连续诊断和随访。
在过去10年里，我们随访了170例ET患者和149例PV患者，这些患者均根据真性红细胞增多症研究组（PVSG）的标准进行诊断。根据诊断时的年龄，将患者分为3组（A组<40岁，B组41 - 65岁，C组>65岁）。
对于所有PV患者，采用放血疗法和/或骨髓抑制疗法，使血细胞比容水平低于45%。对于有重大血管并发症阳性病史或血小板极度增多的ET患者，给予羟基脲治疗。对于有微血管病变或既往有血栓形成的患者（PV患者在存在动脉粥样硬化危险因素时也给予），给予阿司匹林治疗（ASA）（每日100毫克）。
接受和未接受ASA治疗的ET和PV患者发生MI的频率。
ET患者中有9.4%发生MI，PV患者中有11.4%发生MI。PV患者中有17.6%在发生MI时年龄小于40岁，而ET患者中这一比例为0%。ET发生MI的患者中有75%、PV发生MI的患者中有70.6%有动脉粥样硬化危险因素，如吸烟、高血压、糖尿病、血脂异常。所有发生MI的患者在血栓形成后均接受每日100毫克的ASA治疗，ET组中有4例随后发生短暂性脑缺血发作（TIA）。尽管接受了ASA治疗，PV组中有4例患者在随访期间发生TIA，2例发生外周动脉病。
年龄小于40岁的ET患者发生MI的情况比老年患者少见。ET和PV患者中MI与心血管危险因素常并存。低剂量ASA可能能够减少血小板计数升高且有常见动脉粥样硬化危险因素患者的冠状动脉血栓形成数量，而不增加出血并发症。然而，必须评估更多人群以证实我们的假设。
