- 期刊
Acute Thrombosis After Elective Direct Intracoronary Stenting in Primary Antiphospholipid Syndrome: A Case Report
原發性抗磷脂質抗體症候群患者於支架置放術後發生急性血管栓塞─病例報告
摘要
抗磷脂質抗體症候群是一種不常見易發生血栓的病變之一，近幾年來案例不斷地被發現。此症候群的診斷和靜脈或動脈的血栓形成有關。患者臨床表現通常是深層靜脈栓塞、肺栓塞、血栓栓塞性中風或心肌梗塞。本文報告一位61歲女性患者，因三個月來更頻繁的胸悶而來院檢查。在接受運動心電圖和核子醫學掃瞄檢查後，住院接受選擇性的心導管檢查，但在直接之冠狀動脈內之支架置放術後，發生急性血管栓塞。再次的冠狀動脈氣球擴張術、延長肝素的使用和GP llb-llla拮抗劑的使用，成功地再度打通患者的血管。此外，實驗室檢查發現PTT延長和抗心臟脂質抗體呈陽性反應。這些發現都符合抗磷脂質抗體症候群的診斷且因無紅斑性狼瘡和其他免疫系統病變的典型症狀，於是她被診斷為原發性之抗磷脂質抗體症候群的患者。之後，我們給予患者長期的口服抗凝血劑的治療且發揮功效，本病例報告可能是國內第一篇原發性抗磷脂質抗體症候群患者發生急性之冠狀動脈內支架栓塞的文獻。
並列摘要
Antiphospholipid syndrome (APS) is an uncommon prothrombotic disorder that has been increasingly recognized in recent years. The diagnosis of APS must be associated with venous or arterial thrombosis or both. Patients with APS usually present with recurrent deep vein thrombosis, pulmonary thromboembolism, thromboembolic stroke, or myocardial infarction. ere, we report a case of a 61-year-old female who presented with a 3-month history of increasingly frequent retrosternal chest tightness. After treadmill test and thallium-201 myocardial perfusion scan, she was admitted and underwent elective coronary angiography but developed acute thrombosis after direct intracoronary stenting. She was successfully rescued with repeat percutaneous transluminal coronary angioplasty and prolonged heparin and glycoprotein IIb / IIIa antagonist use. Laboratory data showed prolongation of partial thromboplastin time and positive anti-cardiolipin antibody. These findings satisfied the criteria for APS; the patient was diagnosed with primary APS because she had neither typical symptoms nor signs of systemic lupus erythematosus or other immunologic disorders. Thereafter, long-term oral anticoagulant appeared to be effective. To our knowledge, this is the first report of acute stent thrombosis in a patient with primary APS.
延伸閱讀
- 顏志軒、李秉穎、侯嘉殷、周友三、蔡正河（2005）。急性心肌梗塞在系統性紅斑性狼瘡合併抗磷脂抗體症候群與嚴重性血小板低下症－一病例報告暨文獻回溯。內科學誌，16(5)，246-250。https://doi.org/10.6314/JIMT.2005.16(5).07
- Yang, R. S., Ho, H. H., Chen, J. Y., Lee, S. Y., Wu, Y. J. J., & Luo, S. F. (1994). 重壘症候群病人合併抗磷脂抗體陽性及腦血管瘤破裂－病例報告. Formosan Journal of Rheumatology, 11(3&4), 1-12. https://doi.org/10.6313/FJR.199411_11(3_4).0001
- 李誌謙、林重榮（2018）。放射影像（七十）抗磷脂質抗體症候群引起栓塞性腦中風之個案報告及影像學表現。臨床醫學月刊，81(6)，374-376。https://doi.org/10.6666/ClinMed.201806_81(6).0068
- 周詠富、顏威彰、戴家煌、官大紳、洪章仁（2007）。抗磷脂抗體症病患併發慢性硬腦膜下出血：病例報告。台灣復健醫學雜誌，35(2)，111-116。https://doi.org/10.6315/2007.35(2)07
- Lin, K. M., Wang, M. C., Lee, C. H., Chiu, C. K., & Chen, C. J. (2005). 血漿交換術合併脈衝式環磷醯胺靜脈注射治療在全身性紅斑性狼瘡併血栓性小血管病變：一病例報告暨文獻回顧. Formosan Journal of Rheumatology, 19(3&4), 142-150. https://doi.org/10.6313/FJR.2005.19(3-4).10