- 期刊
- OpenAccess
Non-Atherosclerotic Acute Myocardial Infarction in a Young Man with Nephrotic Syndrome
非動脈粥狀硬化的急性心肌梗塞：一腎病症後群病例報告
摘要
腎病症候群（Nephrotic syndrome）的患者常有動脈粥狀硬化的許多危險因子，如：高脂血症及血內纖維蛋白原過多症；但，動脈粥狀硬化是否在腎病症候群患者加速其發生，目前仍無定論。腎病症候群造成的血栓栓塞症（Thromboembolism）常發生在靜脈，尤其是膜性腎病變患者，包括：深度靜脈栓塞、肺栓塞及腎靜脈栓塞；但動脈栓塞症，卻很少見。我們提出一罕見的病例，三十三歲的年輕男性，發生急性心肌梗塞（acute myocardial infarction）合併腎病症候群，經腎臟切片檢查證實為微細病變（minimal change disease），心導管檢查發現冠狀動脈的左前降支和左迴旋支被血栓完全阻塞；經一週治療後，心導管追蹤檢查，發現原來的栓塞消失，且沒有動脈粥狀硬化的病灶，故我們認為冠狀動脈栓塞的發生與腎病症候群有密切的關係。
並列摘要
Patients with nephrotic syndrome (NS) usually have several risk factors, such as hyperlipidemia and hyperfibrinogenemia, which contribute to atherosclerosis in non-nephrotic individuals. However, it is still unclear whether atherosclerosis is uniformly accelerated in NS. Thromboembolism in NS occurs most often in venous sites, including: deep vein thrombosis, pulmonary embolism, and renal vein thrombosis. It rarely involves arterial system, such as the coronary arteries. We hereby report a 33-year-old male with minimal change NS, who presented with an acute myocardial infarction. (AMI) Initial coronary angiography revealed total occlusion with thrombus formation in the left anterior descending and left circumflex arteries. Thrombolytic therapy was started, and repeated coronary angiography one week later documented disappearance of the previous occlusion. The coronary arteries were free of any significant atherosclerotic change. The younger age and the lack of angiographically-demonstrable atherosclerosis suggest a close relationship between NS and coronary thrombosis.