系统性红斑狼疮(SLE)是一种慢性自身免疫性疾病,可引起多器官系统损伤,心脏受累率超过50%,冠状动脉粥样硬化性心脏病(CHD)是其常见并发症,患病风险显著高于普通人群。本文报道了一例42岁女性SLE合并不稳定性心绞痛患者。冠状动脉造影显示左前降支及右冠状动脉重度狭窄,术中植入多枚支架并行高压球囊扩张,术后血管通畅,患者恢复良好,随访未发生急性心血管事件。SLE相关CHD的发病机制涉及慢性炎症、免疫异常和传统心血管危险因素协同作用,患者常表现非典型症状,诊断需结合病史、影像学和实验室评估。治疗以控制SLE炎症、预防血栓和管理心血管风险为核心,严重狭窄者可选择经皮冠状动脉介入治疗(PCI)。本研究结合病例与文献,强调早期识别、综合评估和多学科协作对改善SLE合并CHD患者预后的重要性。Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can cause multi-organ system damage, with cardiac involvement reported in over 50% of cases. Coronary heart disease (CHD) is a common complication of SLE, with a significantly higher prevalence compared to the general population. This article reports a case of a 42-year-old female patient with SLE complicated by unstable angina. Coronary angiography revealed severe stenosis in the left anterior descending artery and the right coronary artery. Multiple stents were implanted during the procedure, followed by high-pressure balloon dilation. Postoperatively, the blood vessels remained unblocked, the patient recovered well, and no acute cardiovascular events occurred during follow-up. The pathogenesis of SLE-associated CHD involves the interplay of chronic inflammation, immune dysfunction, and traditional cardiovascular risk factors. Patients often present with atypical symptoms, and diagnosis requires a combination of medical history, imaging, and laboratory evaluations. Treatment focuses on controlling SLE-related inflammation, preventing thrombosis, and managing cardiovascular risks. For severe stenosis, percutaneous coronary intervention (PCI) is a viable option. This study integrates case findings with a literature review, highlighting the importance of early recognition, comprehensive evaluation, and multidisciplinary collaboration in improving outcomes for patients with SLE and CHD.
目的系统评价冠心病患者血浆氧化三甲胺(TMAO)水平与主要不良心血管事件(MACE)和全因死亡的关系。方法通过计算机搜索中国知网、万方数据库、Pubmed、Embase、Cochrane Library、Web of Science等公开发表的血浆TMAO水平与冠心病患者发...
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目的系统评价冠心病患者血浆氧化三甲胺(TMAO)水平与主要不良心血管事件(MACE)和全因死亡的关系。方法通过计算机搜索中国知网、万方数据库、Pubmed、Embase、Cochrane Library、Web of Science等公开发表的血浆TMAO水平与冠心病患者发生MACE和全因死亡关系的前瞻性队列研究。检索时限从建库至2023年2月,通过纽卡斯尔-渥太华量表(NOS)进行质量评价后提取纳入文献的相关数据,采用Stata 17.0软件进行荟萃分析及剂量反应关系分析。结果共纳入13篇文献的共12999例患者。荟萃分析结果显示,血浆TMAO水平与冠心病患者发生MACE明显相关(HR=1.79,95%CI:1.53~2.09);亚组分析结果显示,与随访时间≤3年相比,随访时间>3年的冠心病患者发生MACE风险与血浆TMAO水平相关性更高(分别为HR=1.75,95%CI:1.48~2.09;HR=1.95,95%CI:1.38~2.72)。血浆TMAO水平与冠心病患者全因死亡也明显相关(HR=2.15,95%CI:1.55~2.98);亚组分析结果显示,与随访时间≤3年相比,随访时间>3年的冠心病患者全因死亡风险与血浆TMAO水平相关性更高(分别为HR=2.03,95%CI:1.14~3.62;HR=2.10,95%CI:1.59~2.78)。剂量反应分析显示,血浆TMAO水平每升高1μmol/L,MACE发生风险增加4.5%,全因死亡风险增加5.8%。结论血浆TMAO水平与冠心病患者发生MACE和全因死亡风险呈线性剂量反应关系。
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