广泛型大动脉炎伴双肾动脉狭窄并发心力衰竭1例

耿明慧; 张伟; 林海霞; 姚述远; 干学东; 高苹

doi:10.13201/j.issn.1001-1439.2022.05.017

广泛型大动脉炎伴双肾动脉狭窄并发心力衰竭1例

- 1.
  武汉大学中南医院肾内科(武汉，430071)
- 2.
  武汉大学中南医院心内科

详细信息

通讯作者: 高苹，E-mail：gp6680@sina.com

中图分类号: R544.1

收稿日期: 2021-07-15

刊出日期: 2022-05-13

Extensive Takayasu arteritis with bilateral renal artery stenosis complicated with heart failure—one case report

- 1.
  Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China
- 2.
  Department of Cardiology, Zhongnan Hospital, Wuhan University

More Information

Corresponding author: GAO Ping, E-mail: gp6680@sina.com

Received Date: 15 July 2021

Publish Date: 13 May 2022

摘要

摘要: 67岁的女性患者，诊断大动脉炎(TA)，主要表现为心力衰竭、头晕、胸闷及严重的下肢高血压。双肾动脉重度狭窄引起的继发性高血压，因炎症同时累及双侧锁骨下动脉致双上肢血压假性正常而被掩盖。长期慢性肾血管性高血压引起的后负荷增加，加上炎症累及冠状动脉而加快了心力衰竭的进展。血管造影等证实了TA的诊断，经糖皮质激素、免疫抑制剂抗炎治疗，炎症指标恢复正常，后成功地实施了双肾动脉的介入治疗。
- 大动脉炎 /
- 肾动脉狭窄 /
- 介入治疗
Abstract: The patient was a 67-year-old female with a diagnosis of Takayasu Arteritis(TA), which mainly presents with heart failure, dizziness, chest tightness, and severe lower extremity hypertension. Secondary hypertension caused by severe stenosis of both renal arteries, but was masked by pseudo-normal blood pressure in both upper extremities caused by simultaneous involvement of bilateral subclavian arteries by inflammation. Increased afterload from long-term chronic renovascular hypertension, coupled with inflammation involving coronary arteries, accelerates the progression of heart failure. Angiography confirmed the diagnosis of TA. After anti-inflammatory treatment with glucocorticoids and immunosuppressive agents, the inflammatory indexes returned to normal. Interventional therapy of both renal arteries was successfully performed.
- Takayasu arteritis /
- renal artery stenosis /
- interventional therapy

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图 1 患者主动脉CTA及冠脉造影

Figure 1. Computed tomography angiography and coronary angiography of the patient

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表 1 治疗前后部分辅助检查指标对比

Table 1. Comparison of some auxiliary examination indicators before and after treatment

辅助检查	TNI/(pg·mL^-1)	BNP/(pg·L^-1)	Scr/(μmol·L^-1)	ESR/(mm·h^-1)	CRP/(mg·L^-1)	IL-6/(pg·mL^-1)	LVEF/%	eGFR/[mL·min^-1·(1.73m²)^-1]	心包积液
入院时	116.6	1248.6	175.1	77	48.4	22.38	36	25.57	中-大量
出院时	9.5	42.4	109.5	9	3	10.7	54	45.11	少量

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参考文献(14)

[1]	Arend WP, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis[J]. Arthritis Rheum, 1990, 33(8): 1129-1134.
[2]	Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis[J]. Ann Intern Med, 1994, 120(11): 919-929. doi: 10.7326/0003-4819-120-11-199406010-00004
[3]	大动脉炎相关高血压诊治多学科共识中国专家组. 中国大动脉炎相关高血压诊治多学科专家共识[J]. 复旦学报(医学版), 2021, 20: 1-13. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202102001.htm
[4]	Cong X, Dai S, Feng X, et al. Takayasu's arteritis: clinical features and outcomes of 125 patients in China[J]. Clinical Rheumatology, 2010, 29(9): 973-981. doi: 10.1007/s10067-010-1496-1
[5]	Hellmich B, Agueda AF, Monti S, et al. Treatment of giant cell arteritis and takayasu arteritis-current and future[J]. Curr Rheumatol Rep, 2020, 22(12): 84. doi: 10.1007/s11926-020-00964-x
[6]	孙璐, 任卫东, 张昕彤, 等. 影像学评估活动期大动脉炎研究进展[J]. 中国介入影像与治疗学, 2020, 17(5): 311-314. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX202005017.htm
[7]	陈敏, 高洁, 牛慧敏, 等. SMI评估多发性大动脉炎颈动脉增厚管壁内新生血管治疗前后的变化[J]. 临床心血管病杂志, 2021, 37(2): 161-166. http://lcxb.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=d9f23363-7cb9-4881-8c50-d30fc45a6160
[8]	Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis[J]. Annals of the Rheumatic Diseases, 2019, 79(1): 19-30.
[9]	Hamzaoui A, Salem R, Klii R, et al. Pericarditis as an initial symptom in Takayasu arteritis[J]. Anadolu Kardiyoloji Dergisi-The Anatolian Journal of Cardiology, 2011, 11(4): 375-376.
[10]	Li J, Sun F, Chen Z, et al. The clinical characteristics of Chinese Takayasu's arteritis patients: a retrospective study of 411 patients over 24 years[J]. Arthritis Research & Therapy, 2017, 19(1): 111.
[11]	王茜婷, 陈明, 郑博, 等. 支架术治疗粥样硬化性肾动脉狭窄的临床疗效[J]. 临床心血管病杂志, 2013, 29(10): 782-784. http://lcxb.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=8b956997-5722-49d0-8f6a-e0e4c07ee294
[12]	倪钧, 沈卫峰, 张瑞岩, 等. 影响冠心病并肾动脉狭窄患者肾动脉支架术后血压改善因素的探讨[J]. 临床心血管病杂志, 2005, 21(8): 452-454. doi: 10.3969/j.issn.1001-1439.2005.08.002 http://lcxb.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=74e1b186-e5d9-496a-9d6e-4aacc740acaa
[13]	Lee K, Kang W C, Ahn T, et al. Long-term outcome of drug-eluting stent for coronary artery stenosis in Takayasu's arteritis[J]. Int J Cardiol, 2010, 145(3): 532-535. doi: 10.1016/j.ijcard.2010.04.066
[14]	Agarwal G, Vats HS, Raval AN, et al. Chronic total occlusion and successful drug-eluting stent placement in Takayasu arteritis-induced renal artery stenosis[J]. Clin Med Res, 2013, 11(4): 233-236.