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摘要: 心腔内血栓形成是系统性红斑狼疮(systemic lupus erythematosus,SLE)继发抗磷脂综合征(antiphospholipid syndrome,APS)的罕见并发症,治疗难度极大。本文报道1例SLE合并心内血栓、肺栓塞病例,病情复杂,猝死风险高,血栓和出血状态下的抗凝选择、感染状态下的原发病评估和治疗均较为棘手。经过多学科诊疗,在内科积极治疗的基础上,创造手术条件并选择恰当时机完成手术治疗,病情得到有效控制。Abstract: Intracardiac thrombus is a rare complication of Antiphospholipid syndrome secondary to systemic lupus erythematosus (SLE). Its treatment is extremely tough and requires a multidisciplinary approach. We reported a case of SLE with intracardiac thrombus and pulmonary embolism. The patient was complicated with hemoptysis and kidney injury, and had a high risk of sudden death from incidental thrombus shedding off. In the state of thrombosis and hemorrhage, the management of anticoagulation and the evaluation and treatment of the primary disease complicated with infection are challenging. The multidisciplinary collaboration helpedus to create a more favorable surgical condition while controlling SLE aggressively. After surgical treatment at the proper time, the outcome of the patient was satisfying.利益冲突 无
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[1] 徐希奇,荆志成. 第六届世界肺高血压会议:聚焦肺高血压定义与诊断分类更新[J]. 协和医学杂志,2018,9:197-201. [2] Cervera R, Serrano R, Pons-Estel GJ, et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period:a multicentre prospective study of 1000 patients[J]. Ann Rheum Dis, 2015, 74:1011-1018. https://pubmed.ncbi.nlm.nih.gov/24464962/ [3] Vnlü O, Zuily S, Erkan D. The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus[J]. Eur J Rheumatol, 2016, 3:75-84. doi: 10.5152/eurjrheum.2015.0085 [4] Chung WS, Lin CL, Chang SN, et al. Systemic lupus erythematosus increases the risks of deep vein thrombosis and pulmonary embolism:a nationwide cohort study[J]. J Thromb Haemost, 2014, 12:452-458. doi: 10.1111/jth.12518 [5] Tektonidou MG, Andreoli L, Limper M, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults[J]. Ann Rheum Dis, 2019, 78:1296-1304. doi: 10.1136/annrheumdis-2019-215213 [6] Kanakis MA, Kapsimali V, Vaiopoulos AG, et al. The lung in the spectrum of antiphospholipid syndrome[J]. Clin Exp Rheumatol, 2013, 31:452-457. [7] Prashanth P, Mukhaini MK. Primary antiphospholipid syndrome with recurrent coronary thrombosis, acute pulmonary thromboembolism and intracerebral hematoma[J]. J Invasive Cardiol, 2009, 21:E254-E258. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=Open J-Gate000001859680 [8] Zifman E, Rotman-Pikielny P, Berlin T, et al. Insertion of inferior vena cava filters in patients with the antiphospholipid syndrome[J]. Semin Arthritis Rheum, 2009, 38:472-477. doi: 10.1016/j.semarthrit.2008.01.016 [9] Kaplan SD, Chartash EK, Pizzarello RA, et al. Cardiac manifestations of the antiphospholipid syndrome[J]. Am Heart J, 1992, 124:1331-1338. doi: 10.1016/0002-8703(92)90420-Z [10] Dhibar DP, Sahu KK, Varma SC, et al. Intra-cardiac thrombus in antiphospholipid antibody syndrome:An unusual cause of fever of unknown origin with review of literature[J]. J Cardiol Cases, 2016, 14:153-156. doi: 10.1016/j.jccase.2016.07.005 [11] Cianciulli TF, Saccheri MC, Redruello HJ, et al. Right atrial thrombus mimicking myxoma with pulmonary embolism in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome[J]. Tex Heart Inst J, 2008, 35:454-457. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2607098/ [12] Khalid U, Hirudayaraj P, Lakkis N, et al. Left atrial thrombus mimicking a myxoma in a patient with systemic lupus erythematosus[J]. Hellenic J Cardiol, 2014, 55:167-170. https://www.ncbi.nlm.nih.gov/pubmed/24681796 [13] Willens HJ, Lowery MH, Lopez E, et al. Rapid resolution of left ventricular thrombus in antiphospholipid syndrome[J]. Echocardiography, 2003, 20:67-70. doi: 10.1046/j.1540-8175.2003.00009.x [14] Zahid H, Hassan S, Gul S, et al. Co-existing Bilateral Pulmonary Embolism and Intra-cardiac Mass:A Case of Catastrophic Antiphospholipid Syndrome-like Disease[J]. Cureus, 2018, 10:e3438. [15] Tektonidou MG, Andreoli L, Limper M, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults[J]. Ann Rheum Dis, 2019,78:1296-1304. doi: 10.1136/annrheumdis-2019-215213 [16] Tselios K, Gladman DD, Urowitz MB. Systemic lupus erythematosus and pulmonary arterial hypertension:links, risks, and management strategies[J]. Open Access Rheumatol, 2016, 9:1-9. doi: 10.2147/OARRR.S123549 [17] Lai YC, Potoka KC, Champion HC, et al. Pulmonary arterial hypertension:the clinical syndrome[J]. Circ Res, 2014, 115:115-130. doi: 10.1161/CIRCRESAHA.115.301146 [18] Hemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute[J]. Pulm Circ, 2015, 5:435-465. doi: 10.1086/682230 [19] Tanaka E, Harigai M, Tanaka M, et al. Pulmonary hypertension in systemic lupus erythematosus:evaluation of clinical characteristics and response to immunosuppressive treatment[J]. J Rheumatol, 2002, 29:282-287. https://www.jrheum.org/content/29/2/282 [20] Gonzalez-Lopez L, Cardona-Muñoz EG, Celis A, et al. Therapy with intermittent pulse cyclophosphamide for pulmonary hypertension associated with systemic lupus erythemato-sus[J]. Lupus, 2004, 13:105-112. doi: 10.1191/0961203304lu509oa [21] Sanchez O, Sitbon O, Jaïs X, et al. Immunosuppressive therapy in connective tissue diseases-associated pulmonary arterial hypertension[J]. Chest, 2006, 130:182-189. doi: 10.1378/chest.130.1.182 -
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