本文選題：銀屑病 + 冠狀動(dòng)脈粥樣硬化性心臟病�。� 參考：《山東大學(xué)》2012年碩士論文

【摘要】：背景： 近年來(lái),銀屑病與冠心病之間的關(guān)系逐漸受到國(guó)外學(xué)者關(guān)注；相比而言,就我們所知,國(guó)內(nèi)這方面的相關(guān)報(bào)道則極少。銀屑病患者合并冠心病的發(fā)病率是正常人的1倍以上。一方面,銀屑病患者群體合并吸煙、高血壓、高血脂及糖尿病等冠心病傳統(tǒng)危險(xiǎn)因素的比例較正常人群高,且部分用于治療銀屑病的藥物可能會(huì)誘發(fā)冠心病或加重其病情；而另一方面,銀屑病本身是否即為冠心病的一個(gè)獨(dú)立危險(xiǎn)因素,目前尚存爭(zhēng)議。故現(xiàn)在尚不清楚銀屑病與冠心病的確切關(guān)系。 目的： 本文通過(guò)報(bào)道兩例診斷明確的銀屑病合并冠心病的患者的病例,旨在試圖引起臨床醫(yī)生對(duì)銀屑病與冠心病關(guān)系的注意,進(jìn)而也更好研究二者之間的關(guān)系。 方法： 通過(guò)對(duì)山東省立醫(yī)院心血管內(nèi)科2011年兩例診斷明確的銀屑病合并冠心病的患者的臨床資料進(jìn)行回顧性分析,并對(duì)國(guó)內(nèi)外相關(guān)的文獻(xiàn)進(jìn)行復(fù)習(xí)。 病例一：患者,男性,37歲,主訴為“反復(fù)活動(dòng)性胸悶胸痛1月余”。自述高血壓病史4年,血壓最高為160/90mmHg,平時(shí)規(guī)律服用ACEI及CCB類(lèi)降壓藥,血壓控制達(dá)標(biāo)。否認(rèn)飲酒、吸煙、高血脂及糖尿病病史,否認(rèn)早發(fā)冠心病家族史�；颊咦允龌笺y屑病22年余,除間斷局部外涂氯倍他索軟膏(具體不詳)外,否認(rèn)其他治療。查體：體型偏胖,血壓135/85mmHg,除四肢關(guān)節(jié)伸側(cè)可見(jiàn)散在紅斑伴少量鱗屑外,無(wú)其他特殊陽(yáng)性體征。實(shí)驗(yàn)室檢查：血糖無(wú)明顯異常,血脂中LDL-C及TG明顯升高,HDL下降。肝腎功、ESR均正常,心肌損傷標(biāo)志物陰性。入院心電圖未見(jiàn)明顯異常,平板試驗(yàn)示V1-V4導(dǎo)聯(lián)ST段弓背向上抬高0.1mV；心臟超聲示左心室節(jié)段性運(yùn)動(dòng)不良,胸部X線檢查未見(jiàn)明顯異常。入院診斷：1、冠狀動(dòng)脈粥樣硬化性心臟病,不穩(wěn)定型心絞痛；2、高血壓病(2級(jí),極高危)；3、尋常型銀屑病。住院期間行CAG示：LAD近段80%狹窄,置入支架一枚。術(shù)后隨訪3個(gè)月,患者再未訴胸悶胸痛癥狀發(fā)作。 病例二：患者,男性,33歲,主訴為“活動(dòng)性胸痛3個(gè)月,加重4天”。平時(shí)僅偶少量飲酒(50g/周),否認(rèn)吸煙、高血壓、高血脂及糖尿病病史,否認(rèn)早發(fā)冠心病家族史。患者自述患銀屑病13年余,除間斷局部外涂卡泊三醇軟膏及數(shù)年前曾口服數(shù)副中藥(具體不詳)外,否認(rèn)其他治療。查體：非肥胖體型,血壓135/80mmHg,除四肢關(guān)節(jié)伸側(cè)可見(jiàn)散在紅斑伴少量鱗屑外,無(wú)其他特殊陽(yáng)性體征。實(shí)驗(yàn)室檢查：血糖、血脂指標(biāo)無(wú)明顯異常,肝腎功、ESR均正常,心肌損傷標(biāo)志物陰性；入院心電圖未見(jiàn)明顯異常,平板試驗(yàn)示V4-V6,I、aVL導(dǎo)聯(lián)ST段弓背向上抬高0.1mV；心臟超聲及胸部X線檢查均未見(jiàn)明顯異常。入院診斷：1、冠狀動(dòng)脈粥樣硬化性心臟病,不穩(wěn)定型心絞痛；2、尋常型銀屑病。住院期間行CAG示：LCX近段85%狹窄,置入支架一枚。術(shù)后隨訪3個(gè)月,患者再未訴胸痛癥狀發(fā)作。 結(jié)果： 上述病例個(gè)案中,患者一除了患銀屑病外,還合并了肥胖、高血壓及血脂紊亂等心血管病的危險(xiǎn)因素；而患者二除患尋常型銀屑病外,并無(wú)肥胖、長(zhǎng)期大量飲酒、吸煙、高血壓、高血脂、糖尿病及早冠心病家族史等冠心病的傳統(tǒng)危險(xiǎn)因素；而兩名患者用藥情況引起冠心病的可能性亦都不大,但二者均被明確診斷合并了冠心病。 結(jié)論： 銀屑病不但可通過(guò)合并心血管病的危險(xiǎn)因素進(jìn)而促進(jìn)冠心病的發(fā)生,而且其本身可能即為冠心病的一個(gè)獨(dú)立危險(xiǎn)因素。
[Abstract]:Background :

In recent years , the relationship between psoriasis and coronary heart disease has gradually been paid attention to by scholars abroad ;
In contrast , the incidence of coronary heart disease in patients with psoriasis is more than one - fold higher than that of normal people . In the one hand , the proportion of patients with psoriasis combined with smoking , hypertension , hyperlipemia and diabetes is higher than that of the normal population , and the drugs used for the treatment of psoriasis may induce coronary heart disease or aggravate the condition of coronary heart disease ;
On the other hand , whether psoriasis itself is an independent risk factor for coronary heart disease is still controversial , so it is not clear that psoriasis is related to coronary heart disease .

Purpose :

This paper reports two cases of patients with definite psoriasis complicated with coronary heart disease . It is intended to draw attention to the relationship between psoriasis and coronary heart disease and to study the relationship between them .

Method :

Through a retrospective analysis of the clinical data of two patients with coronary heart disease diagnosed by cardiovascular internal medicine in Shandong Province in 2011 , the relevant literatures were reviewed at home and abroad .

Case 1 : The patient , male , 37 years old , complained of " repeated active chest distress and chest pain for more than 1 month " . In the history of hypertension , the highest blood pressure was 160 / 90 mmHg . There was no other special positive sign in the history of hypertension , smoking , hyperlipidemia and diabetes . No other special positive signs were denied .
Cardiac ultrasound showed poor segmental motion of left ventricle and no obvious abnormality in chest X - ray examination . Admission diagnosis : 1 , coronary atherosclerotic heart disease , unstable angina pectoris ;
2 . Hypertension ( Level 2 , Very High Risk ) ;
3 . vulgaris psoriasis . CAG was performed during hospitalization : 80 % stenosis in the proximal segment of LAD , one stent was placed . After 3 months of follow - up , the patient did not complain of chest distress and chest pain .

Case 2 : The patient , male , 33 years old , complained of " active chest pain for 3 months , aggravated for 4 days " . Only a small amount of alcohol ( 50g / week ) was used to deny the history of smoking , hypertension , hyperlipidemia and diabetes . There were no other treatments .
There was no obvious abnormality in the ECG of admission , and the plate test showed that the ST segment of ST segment of V4 - V6 , I , aVL was up 0.1mV upward .
There were no significant abnormalities in both cardiac ultrasound and chest X - ray examination . Admission diagnosis : 1 , coronary atherosclerotic heart disease , unstable angina pectoris ;
2 . vulgaris psoriasis . CAG showed that the proximal segment of LCX was 85 % stenosis and stent was placed one . After 3 months of follow - up , the patient did not complain of chest pain .

Results :

In the case of the above cases , the patient had the risk factors of cardiovascular diseases such as obesity , hypertension and blood lipid disorders , in addition to psoriasis .
In addition to the common psoriasis vulgaris , the patient has no traditional risk factors such as obesity , long - term drinking , smoking , hypertension , hyperlipidemia , diabetes , and family history of coronary heart disease .
The likelihood of coronary heart disease was not significant in both patients , but both were clearly diagnosed with coronary heart disease .

Conclusion :

The psoriasis not only can promote the occurrence of coronary heart disease by combining the risk factors of cardiovascular disease , but also may be an independent risk factor for coronary heart disease .
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R541.4;R758.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 劉承煌;毛維翰;李君蒂;王慧英;;上海市1985年銀屑病流行病學(xué)調(diào)查報(bào)告[J];皮膚病與性病;1990年02期

2 龐曉文;楊雪琴;;350例住院銀屑病患者伴發(fā)疾病的臨床分析[J];空軍總醫(yī)院學(xué)報(bào);2006年04期

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本文編號(hào)：1948309