陈泽锋　税星　陈璘

【摘要】抗磷脂综合征（APS）是一种自身免疫性疾病，其特征表现是抗磷脂抗体持续存在且合并血管血栓形成。该文报道一例以急性血栓形成致AMI为首发表现的APS患者的诊疗过程及随访情况。该患者无明显冠状动脉粥样硬化性心脏病（冠心病）危险因素，因发热查因入院，期间突发AMI，冠状动脉造影示右冠状动脉血栓形成，血栓抽吸后未植入支架。予抗凝抗血小板及抗风湿等治疗，10 d后复查冠状动脉造影未见明显异常。随访半年期间未再发血栓栓塞事件。该病例提示，对于冠状动脉造影以冠状动脉血栓形成为主且无明显冠心病危险因素的AMI患者，建议行APS筛查，以助于明确诊断及指导治疗。

【关键词】抗磷脂综合征;冠状动脉血栓栓塞;急性心肌梗死

【Abstract】Antiphospholipid syndrome （APS） is an autoimmune syndrome characterized by persistent presence of antiphospholipid antibodies complicated with vascular thrombosis. In this article， we reported the diagnosis， treatment and follow-up of one case of APS presenting with acute myocardial infarction （AMI）. The patient did not have significant risk factors of coronary heart disease and was admitted to our hospital because of fever of unknown origin. During hospitalization， the patient suddenly developed AMI. Coronary angiography revealed thombosis in the right coronary artery， and no coronary stent was implanted after thrombus aspiration. After antithrombotic and antirheumatic therapy for 10 days， coronary angiography revealed no thombosis or stenosis in the right coronary artery. No arterial or venous thrombosis events were found during the follow-up period. This case suggests that screening of APS is recommended for AMI patients presenting with coronary arterial thrombosis while without significant risk factors of coronary heart disease， which contributes to confirming the diagnosis and offering guidance on treatment.

【Key words】Antiphospholipid syndrome;Coronary artery thrombosis;Acute myocardial infarction

抗磷脂綜合征（APS）是一种自身免疫性疾病，其特征表现是抗磷脂抗体持续存在且合并动静脉血栓形成。APS常继发于SLE等全身性自身免疫性疾病，也可为原发性[1]。原发性APS动脉血栓形成相比静脉血栓形成少见，其动脉血栓最常发生于脑血管，冠状动脉受累相对少见。国内协和医院107例原发性APS患者的数据显示，67.3%的患者发生静脉血栓事件，27.1%的患者发生动脉血栓事件，3.7%的患者发生心肌梗死[2]。因此，并发AMI的APS患者临床上容易漏诊病因。现将我科近期收治的一例以AMI为首发表现的原发性APS患者诊治过程及随访情况总结报告如下。

病例资料

一、主诉、病史及体格检查

患者男，49岁，因反复发热20 d于2019年8月23日入我院感染科。……