|本期目录/Table of Contents|

[1]王静,汤沂,王磊.自发性冠状动脉夹层的诊断及救治分析并文献复习[J].医学研究与战创伤救治(原医学研究生学报),2021,23(05):489-492.[doi:10.3969/j.issn.1672-271X.2021.05.009]
　WANG Jing,TANG Yi,WANG Lei.Spontaneous coronary artery dissection：A case report and review of literature[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(05):489-492.[doi:10.3969/j.issn.1672-271X.2021.05.009]
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自发性冠状动脉夹层的诊断及救治分析并文献复习()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第23卷
期数:
2021年05
页码:
489-492
栏目:
临床研究
出版日期:
2021-09-20

文章信息/Info

Title:
Spontaneous coronary artery dissection：A case report and review of literature
作者:
王静; 汤沂; 王磊
作者单位：210002南京，东部战区总医院（原南京军区总医院）心血管内科（王静、汤沂、王磊）
Author(s):
WANG Jing;  TANG Yi;  WANG Lei
（Department of Cardiology, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China）
关键词:
自发性冠状动脉夹层; 急性冠状动脉综合征; 临床特点
Keywords:
spontaneous coronary artery dissection;  acute coronary syndrome;  clinical characteristics
分类号:
R543.3
DOI:
10.3969/j.issn.1672-271X.2021.05.009
文献标志码:
A
摘要:
目的分析自发性冠状动脉夹层（SCAD）的临床表现尤其冠状动脉造影特征，探讨其发病机制及目前治疗进展。方法回顾性分析东部战区总医院收治的1例发病典型、诊疗资料完整的SCAD女性患者的临床表现尤其冠状动脉影像特征，并复习相关文献资料，总结其临床诊治进展。结果该例患者在因急性冠状动脉综合征（ACS）实施回旋支血管介入治疗后2年再次因ACS收住入院，复查冠脉造影并行血管内超声检查（IVUS），发现2年前造影阴性的前降支发生急性闭塞，发病原因为SCAD。经药物保守治疗后患者病情明显改善并经第3次造影检查确认罪犯血管夹层自行吸收明显。患者出院后1年随访病情稳定。结论SCAD的确切病因依然不明，好发于冠心病危险因素较少的中青年女性，常以ACS症状起病，冠状动脉造影是目前诊断SCAD的金标准，及时规范的治疗可改善SCAD患者的预后。
Abstract:
ObjectiveTo summarize the clinical manifestations, especially the coronary angiography of spontaneous coronary artery dissection (SCAD), and to explore its advances in pathogenesis and in current diagnosis and treatment.MethodsThe clinical manifestations (symptoms, ECGs and especially the coronary angiography and IVUS) of a female patient with SCAD in cardiovascular Department of the Eastern Theater Command Hospital were analyzed. The diagnosis and treatment of SCAD were summarized.ResultsIn this case, the patient was admitted to hospital again due to acute coronary artery syndrome (ACS) 2 years after her first admission of ACS with interventional therapy for circumventing artery. The coronary angiography and intravascular ultrasound examination (AVUS) revealed the acute occlusion of the anterior descending artery, which had no lesion in the previous angiography, and the cause of the disease was SCAD. After conservative treatment with drugs, the patient’s condition was significantly improved and the third angiography confirmed that the self-absorption of the criminal vascular dissection was significantly improved. At present, the patient’s conditionis stable after the follow-up of one year after discharge.ConclusionThe exact etiology of SCAD is still unknown, and it often occurs in young and middle-aged women with fewer risk factors for coronary heart disease, frequently with symptoms of ACS. Coronary angiography is the gold standard for the diagnosis of SCAD at present, and timely and standardized treatment can improve the prognosis of SCAD patients.

参考文献/References:

[1]Hayes SN, Kim ES, Saw J, et al. Spontaneous coronary artery dissection: Current state of the science: A scientific statement from the American Heart Association[J]. Circulation, 2018, 137(19): 523-557.
[2]Gilhofer TS, Saw J. Spontaneous coronary artery dissection: update 2019[J]. Curr Opin Cardiol, 2019, 34(6):594-602.
[3]Nakashima T, Noguchi T, Haruta S, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan [J]. Int J Cardiol, 2016, 207:341-348.
[4]Sun Y, Chen YH, Li YY, et al. Association of TSR1 Variants and Spontaneous Coronary Artery Dissection[J]. J Am Coll Cardiol,2019, 74(2):167-176.
[5]张云雁，吴翔.女性急性心肌梗死的特点研究进展[J].东南国防医药，2018，20（3）：276-280.
[6]Saw J, Mancini GBJ, Humphries KH. Contemporary review on spontaneous coronary artery dissection[J]. J Am Coll Cardiol, 2016, 68(3):297-312.
[7]Adlam D, Olson TM, Combaret N, et al. Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection[J]. J Am Coll Cardiol, 2019, 73(1):58-66.
[8]Adlam D，Alfonso F，Maas A，et al．European Society of Cardiology，acut cardiovascular care association，SCAD study group：a position paper on spontaneous coronary artery dissection[J]. Eur Heart J, 2018, 39(36):3353-3368.
[9]Rigatelli G, Avvocata FD, Picariello C. Characterization of single vs. recurrent spontaneous coronary artery dissection[J]. Asian Cardiovasc Thorac Ann, 2018,26(2):89-93.
[10]王砚青，叶飞，赵艳芳，等. 自发性冠状动脉壁内血肿致急性心肌梗死诊疗分析[J].东南国防医药，2019，21（3）：258-261.
[11]朱冰冰，程训民，王 璟.急诊介入治疗高龄急性心肌梗死患者的疗效及近期安全性评价[J].医学研究生学报，2014，27（11）：1172-1175.
[12]Hassan S, Prakash R, Starovoytov A, et al. Natural history of spontaneous coronary artery dissection with spontaneous angiographic healing[J]. JACC Cardiovasc Interv, 2019,12(6):518-527.
[13]Main A, Saw J. Percutaneous Coronary Intervention for the Treatment of Spontaneous Coronary Artery Dissection[J]. Interv Cardiol Clin, 2019, 8(2):199-208.
[14]Saw J, Humphries K, Aymong E, et al. Spontaneous coronary artery dissection: clinical outcomes and risk of recurrence[J]. J Am Coll Cardiol, 2017,70(9):1148-1158.
[15]Hayes SN, Kim ESH, Saw J, et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association[J]. Circulation, 2018,137(19): e523-e557.
[16]Kim ESH. Spontaneous Coronary-Artery Dissection[J]. N Engl J Med, 2020, 383(24):2358-2370.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2021-10-11