银屑病与冠心病

发布时间：2018-05-28 21:47

本文选题：银屑病 + 冠状动脉粥样硬化性心脏病　；参考：《山东大学》2012年硕士论文

【摘要】：背景：近年来,银屑病与冠心病之间的关系逐渐受到国外学者关注；相比而言,就我们所知,国内这方面的相关报道则极少。银屑病患者合并冠心病的发病率是正常人的1倍以上。一方面,银屑病患者群体合并吸烟、高血压、高血脂及糖尿病等冠心病传统危险因素的比例较正常人群高,且部分用于治疗银屑病的药物可能会诱发冠心病或加重其病情；而另一方面,银屑病本身是否即为冠心病的一个独立危险因素,目前尚存争议。故现在尚不清楚银屑病与冠心病的确切关系。目的：本文通过报道两例诊断明确的银屑病合并冠心病的患者的病例,旨在试图引起临床医生对银屑病与冠心病关系的注意,进而也更好研究二者之间的关系。方法：通过对山东省立医院心血管内科2011年两例诊断明确的银屑病合并冠心病的患者的临床资料进行回顾性分析,并对国内外相关的文献进行复习。病例一：患者,男性,37岁,主诉为“反复活动性胸闷胸痛1月余”。自述高血压病史4年,血压最高为160/90mmHg,平时规律服用ACEI及CCB类降压药,血压控制达标。否认饮酒、吸烟、高血脂及糖尿病病史,否认早发冠心病家族史。患者自述患银屑病22年余,除间断局部外涂氯倍他索软膏(具体不详)外,否认其他治疗。查体：体型偏胖,血压135/85mmHg,除四肢关节伸侧可见散在红斑伴少量鳞屑外,无其他特殊阳性体征。实验室检查：血糖无明显异常,血脂中LDL-C及TG明显升高,HDL下降。肝肾功、ESR均正常,心肌损伤标志物阴性。入院心电图未见明显异常,平板试验示V1-V4导联ST段弓背向上抬高0.1mV；心脏超声示左心室节段性运动不良,胸部X线检查未见明显异常。入院诊断：1、冠状动脉粥样硬化性心脏病,不稳定型心绞痛；2、高血压病(2级,极高危)；3、寻常型银屑病。住院期间行CAG示：LAD近段80%狭窄,置入支架一枚。术后随访3个月,患者再未诉胸闷胸痛症状发作。病例二：患者,男性,33岁,主诉为“活动性胸痛3个月,加重4天”。平时仅偶少量饮酒(50g/周),否认吸烟、高血压、高血脂及糖尿病病史,否认早发冠心病家族史。患者自述患银屑病13年余,除间断局部外涂卡泊三醇软膏及数年前曾口服数副中药(具体不详)外,否认其他治疗。查体：非肥胖体型,血压135/80mmHg,除四肢关节伸侧可见散在红斑伴少量鳞屑外,无其他特殊阳性体征。实验室检查：血糖、血脂指标无明显异常,肝肾功、ESR均正常,心肌损伤标志物阴性；入院心电图未见明显异常,平板试验示V4-V6,I、aVL导联ST段弓背向上抬高0.1mV；心脏超声及胸部X线检查均未见明显异常。入院诊断：1、冠状动脉粥样硬化性心脏病,不稳定型心绞痛；2、寻常型银屑病。住院期间行CAG示：LCX近段85%狭窄,置入支架一枚。术后随访3个月,患者再未诉胸痛症状发作。结果：上述病例个案中,患者一除了患银屑病外,还合并了肥胖、高血压及血脂紊乱等心血管病的危险因素；而患者二除患寻常型银屑病外,并无肥胖、长期大量饮酒、吸烟、高血压、高血脂、糖尿病及早冠心病家族史等冠心病的传统危险因素；而两名患者用药情况引起冠心病的可能性亦都不大,但二者均被明确诊断合并了冠心病。结论：银屑病不但可通过合并心血管病的危险因素进而促进冠心病的发生,而且其本身可能即为冠心病的一个独立危险因素。
[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 .
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R541.4;R758.63

【参考文献】