冠状动脉瘤样扩张伴狭窄闭塞、抗磷脂抗体综合征、肾病综合征、多囊肾一例

王宇鑫; 郭潇潇; 杨德彦; 赵久良; 蒋颖; 胡蓉蓉; 沈东超; 毛玥莹; 王琳; 严晓伟

doi:10.12290/xhyxzz.2021-0678

冠状动脉瘤样扩张伴狭窄闭塞、抗磷脂抗体综合征、肾病综合征、多囊肾一例

Coronary Aneurysm-like Dilation with Stenosis, Anti-phospholipid Antibody Syndrome, Nephrotic Syndrome, and Polycystic Kidney: A Case Report

摘要

摘要: 患者青年男性，早发心肌梗死，合并多囊肾，存在肾病综合征及抗磷脂抗体综合征，冠状动脉造影示多支冠状动脉瘤样扩张伴狭窄闭塞，植入支架后出现支架内反复再狭窄。抗磷脂抗体综合征为反复冠状动脉血栓形成的危险因素，且可累及肾脏并导致肾病综合征，而遗传性多囊肾可有肾病综合征临床表现且可因基因异常合并动脉瘤样病变。遗传因素、免疫因素、代谢因素等均参与其中，经多学科讨论并结合随诊结果，考虑患者为结缔组织病继发抗磷脂抗体综合征、肾病综合征和冠状动脉病变，针对原发病治疗后患者症状及指标均好转。本例患者的诊治拓宽了临床医师对年轻患者冠状动脉疾病背后病因的认识，也体现了多学科诊疗临床思维的重要性。

Abstract: Here we report a case that a young man had early onset myocardial infarction. Coronary angiography showed coronary aneurysm-like dilation and thromboembolism. After stents were implanted, his condition was complicated with repeated stent restenosis. Polycystic kidney, nephrotic syndrome and antiphospholipid antibody syndrome were also present. Antiphospholipid antibody syndrome, a risk factor for recurrent coronary thrombosis, can lead to nephrotic syndrome. Polycystic kidney can be characterized by nephrotic syndrome and may be combined with aneurysmal lesions due to genetic abnormalities. According to the multidisciplinary discussion and follow-up results, the patient was diagnosed as connective tissue diseases and secondary anti-phospholipid antibody syndrome, nephrotic syndrome, and coronary artery lesions. The patient's symptoms improved after treatment for the original disease. The management of this patient broadened our understanding of the etiology of coronary artery disease in young patients and demonstrated the importance of multidisciplinary clinical thinking.

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