汪璐芸.非阻塞性冠状动脉心肌梗死的免疫调节治疗[J].内科急危重症杂志,2022,28(6):464-468
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| DOI：10.11768/nkjwzzzz20220607 |
| 中文关键词: 非阻塞性冠状动脉心肌梗死 冠脉痉挛 心肌炎 免疫调节 糖皮质激素 |
| 英文关键词: |
| 基金项目:国家自然科学基金项目（No:82170283，No:81600236）；华中科技大学同济医学院附属同济医院回国人员启动基金（No:2020HGRY013） |
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| 中文摘要: |
| 摘要 目的：探讨炎症在非阻塞性冠状动脉心肌梗死（MINOCA）发病的病理生理机制中的作用。方法：收集3例MINOCA患者的临床资料，根据其发病特点和治疗反应总结其诊治规律。结果：心肌炎、冠脉周围炎和全身炎症状态均可能是触发MINOCA病理生理过程的始动因素。目前，国内外指南对MINOCA治疗和预防均推荐他汀类药物、血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂（ACEI/ ARB）、β受体阻滞剂和双重抗血小板聚集治疗等药物，但其治疗效果欠佳。本研究结合病例发现加用糖皮质激素等免疫调节治疗可以改善炎症，从而减少MINOCA的反复发作。结论：以糖皮质激素为代表的免疫调节治疗可能给一部分难治性、复发性的MINOCA提供新的治疗思路。 |
| 英文摘要: |
| Abstract Objective: To investigate the role of inflammation in the pathophysiological mechanism of non-obstructive coronary myocardial infarction (MINOCA). Methods: We retrospectively analyzed the clinical data of 3 patients with MINOCA in our hospital and summarized the features and outcomes for them. Results: Myocarditis, pericoronary inflammation and systemic inflammation may be the initial factors to trigger coronary artery lesions of MINOCA. Currently, statins, angiotensin converting enzyme inhibitors/angiotensin receptor antagonists (ACEI/ARB), β-blockers and dual antiplatelet aggregation therapy recommended by domestic and foreign guidelines are not effective in the treatment and prevention of MINOCA. We applied immunoregulatory therapy such as glucocorticoids to relief inflammation and reduce the recurrence of MINOCA. Conclusion: Immunoregulatory therapy may provide a new therapeutic strategy for the refractory and recurrent MINOCA. |
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