系统性红斑狼疮合并冠心病PCI病例分享及文献复习

A Case Report and Literature Review of PCI in Systemic Lupus Erythematosus Complicated with Coronary Heart Disease

摘要: 系统性红斑狼疮(SLE)是一种慢性自身免疫性疾病，可引起多器官系统损伤，心脏受累率超过50%，冠状动脉粥样硬化性心脏病(CHD)是其常见并发症，患病风险显著高于普通人群。本文报道了一例42岁女性SLE合并不稳定性心绞痛患者。冠状动脉造影显示左前降支及右冠状动脉重度狭窄，术中植入多枚支架并行高压球囊扩张，术后血管通畅，患者恢复良好，随访未发生急性心血管事件。SLE相关CHD的发病机制涉及慢性炎症、免疫异常和传统心血管危险因素协同作用，患者常表现非典型症状，诊断需结合病史、影像学和实验室评估。治疗以控制SLE炎症、预防血栓和管理心血管风险为核心，严重狭窄者可选择经皮冠状动脉介入治疗(PCI)。本研究结合病例与文献，强调早期识别、综合评估和多学科协作对改善SLE合并CHD患者预后的重要性。

Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can cause multi-organ system damage, with cardiac involvement reported in over 50% of cases. Coronary heart disease (CHD) is a common complication of SLE, with a significantly higher prevalence compared to the general population. This article reports a case of a 42-year-old female patient with SLE complicated by unstable angina. Coronary angiography revealed severe stenosis in the left anterior descending artery and the right coronary artery. Multiple stents were implanted during the procedure, followed by high-pressure balloon dilation. Postoperatively, the blood vessels remained unblocked, the patient recovered well, and no acute cardiovascular events occurred during follow-up. The pathogenesis of SLE-associated CHD involves the interplay of chronic inflammation, immune dysfunction, and traditional cardiovascular risk factors. Patients often present with atypical symptoms, and diagnosis requires a combination of medical history, imaging, and laboratory evaluations. Treatment focuses on controlling SLE-related inflammation, preventing thrombosis, and managing cardiovascular risks. For severe stenosis, percutaneous coronary intervention (PCI) is a viable option. This study integrates case findings with a literature review, highlighting the importance of early recognition, comprehensive evaluation, and multidisciplinary collaboration in improving outcomes for patients with SLE and CHD.