冠心病合并类风湿关节炎患者PCI术后死亡一例

doi:10.3877/cma.j.issn.2095-655X.2024.04.005

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摘要目的探讨冠心病合并类风湿关节炎（RA）患者经皮冠脉介入术（PCI）后支架内血栓形成的机制，以及PCI的适应证及手术时机的选择。方法选择2021年3月5日济宁医学院附属医院心内科收治的1例冠心病合并RA患者PCI术后死亡病例的临床资料，并复习相关文献。结果患者既往RA病史30年，长期服用激素类药物，病情控制欠佳 ,近10d疼痛加重，既往冠心病病史10年，曾行PCI。抗环瓜氨酸肽抗体85.33U/mL，类风湿因子66.6U/mL，红细胞沉降率42mm/h，C反应蛋白17.4mg/L，D-二聚体0.66mg/L。2021年3月14日，术前冠状动脉CT提示冠状动脉狭窄。2021年3月16日冠状动脉造影示：左前降支（LAD）近段狭窄90%，D1开口狭窄95%。患者行PCI，于LAD近段植入1枚支架。术后30min，患者感心前区剧烈疼痛，急诊冠脉造影示LAD支架内血栓形成，心肌梗死溶栓试验前向血流0级。经积极救治后，患者死亡。结论合并RA急性期的冠心病患者PCI后易形成支架内血栓，术前需充分评估适应证，并选择合适的时机。

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关键词 ：类风湿关节炎, 冠心病, 经皮冠脉介入术, 支架, 血栓形成

Abstract：ObjectiveTo explore the mechanism of stent thrombosis after percutaneous coronary intervention (PCI) in a patient with coronary heart disease and rheumatoid arthritis (RA), and to explore the indications and timing of PCI. MethodsThe clinical data of a patient with coronary heart disease complicated with RA who died after PCI in the Department of Cardiology of the Affiliated Hospital of Jining Medical University on March 5, 2021 were selected, and the relevant literature was reviewed. ResultsThe patient had a 30-year history of RA, which was poorly controlled by long-term use of hormone drugs, and the pain worsened in the past 10 days. The patient had a 10-year history of coronary heart disease and underwent PCI. The anti-cyclic citrulline peptide antibody was 85.33U/mL, rheumatoid factor 66.61U/mL, erythrocyte sedimentation rate 42mm/h, C-reactive protein 17.4mg/L, and D-dimer 0.66mg/L. On March 14, 2021, preoperative coronary angiography showed acute stent thrombosis. On March 16, 2021, coronary angiography showed 90% stenosis in the proximal segment of left anterior descending (LAD) and 95% stenosis in the opening of D1 branch. The patient underwent PCI and a stent was implanted in the proximal segment of the LAD. Thirty minutes after the operation, the patient felt severe pain in the precordial area. Emergency coronary angiography showed thrombosis in the LAD stent, and the thrombolysis in myocardial infarction flow grade was 0. After active treatment, the patient died. ConclusionsCoronary heart disease patients with RA in the acute phase are prone to stent thrombosis after PCI. It is necessary to fully evaluate the indications and choose the appropriate time before PCI.

Key words： Rheumatoid arthritis;Coronary heart disease Percutaneous coronary intervention Stents Thrombosis

收稿日期: 2022-08-17

基金资助:国家自然科学基金（82000269）；济宁市重点研发计划（2020JKNS006）

通讯作者: 甘立军， Email：13792336453@163.com

引用本文:

神童申程张艳艳颜欣卓甘立军. 冠心病合并类风湿关节炎患者PCI术后死亡一例[J]. 中华诊断学电子杂志, 2024, 12(4): 241-244.
Shen Tong1, Shen Cheng1, Zhang Yanyan2, Yan Xinzhuo3, Gan Lijun1. . One case of death in a patient with coronary heart disease complicated with rheumatoid arthritis after PCI. zhzdx, 2024, 12(4): 241-244.

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