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目的:对我国内地过敏反应相关的急性冠状动脉综合征(ACS)病例进行统计和文献分析。方法:在万方数据库、中国知网、PubMed分别进行相关检索。纳入作者明确病例为过敏反应合并ACS(包括心绞痛、急性心肌梗死),数据资料较完整者。分析病例的性别,年龄,变应原,临床表现,治疗,发病机制的讨论,以及文献发表年限等。结果:51篇文献63例病例纳入分析,男性36例(占57.1%)。年龄(17~81)岁,平均(52.6±16.8)岁。文献发表时间最早为1990年。1990-1999年17篇,2000-2009年20篇,2010-2014年6月14篇。变应原包括抗生素等药物,蜂蜇伤,食物,疫苗,染发剂,花粉等。临床表现包括接触变应原后出现过敏反应和ACS相关的症状和体征,心绞痛18例,急性心肌梗死42例,因缺心肌坏死标记物等结果诊断为ACS 3例。8例患者行冠状动脉造影检查,4例正常,4例存在粥样硬化。41例(65.1%)患者存在过敏性休克,7例(11.1%)合并室性心动过速、心室颤动、Ⅲ度房室传导阻滞,8例(占12.7%)合并急性心力衰竭。住院期间死亡7例,占11.1%。抗过敏治疗通常包括糖皮质激素、肾上腺素、多巴胺等。ACS方面的治疗,1例行急诊植入冠状动脉支架,2例行经皮冠状动脉腔内成形术,8例行溶栓治疗,5例应用抗血小板药物,7例应用抗凝药物,15例应用硝酸酯类药物,3例应用钙离子拮抗剂,1例应用调脂药,6例应用止痛药。发病机制的讨论方面,作者考虑过敏性休克为主要或唯一发病机制的文献有27篇。有10篇文献考虑存在冠状动脉痉挛。相关的名称包括Kounis综合征、心脏变态反应、心脏荨麻疹、变态反应性心肌炎等。结论:过敏反应可引起冠状动脉痉挛或血栓形成,导致ACS。休克不是唯一的发病机制。相关名称有待统一。
OBJECTIVE: To carry out statistics and literature analyzes of acute coronary syndrome (ACS) cases related to allergic reactions in the Mainland of China. Methods: Wanfang database, CNKI, PubMed were related search. Including the author of a clear case of allergic reactions combined with ACS (including angina, acute myocardial infarction), the data more complete. Analysis of cases of gender, age, allergens, clinical manifestations, treatment, pathogenesis of the discussion, as well as the literature published years. Results: Totally 63 cases were included in 51 articles, including 36 males (57.1%). Age (17 ~ 81) years old, with an average (52.6 ± 16.8) years. The earliest published date was 1990. 17 articles in 1990-1999, 20 articles in 2000-2009 and 14 articles in 2010-2014. Allergens include antibiotics and other drugs, bee stings, food, vaccines, hair dyes, pollen and so on. Clinical manifestations include allergic reactions and ACS-related symptoms and signs after exposure to allergens, angina pectoris in 18 cases, acute myocardial infarction in 42 cases and diagnosis of ACS due to absence of myocardial necrosis markers. Eight patients underwent coronary angiography, four were normal, and four had atherosclerosis. 41 cases (65.1%) had anaphylactic shock, 7 cases (11.1%) with ventricular tachycardia, ventricular fibrillation, Ⅲ degree atrioventricular block and 8 cases (12.7%) with acute heart failure. 7 died during hospitalization, accounting for 11.1%. Anti-allergy treatment usually includes glucocorticoids, epinephrine, dopamine and the like. In the ACS group, 1 patient underwent emergency coronary stent implantation, 2 underwent percutaneous transluminal coronary angioplasty, 8 underwent thrombolysis, 5 received antiplatelet drugs, 7 received anticoagulant drugs and 15 received anticoagulation Application of nitrates, 3 cases of application of calcium antagonists, 1 case of lipid-lowering drugs, 6 cases of painkillers. In terms of the pathogenesis, there are 27 literatures about the pathogenesis of anaphylactic shock. Ten articles considered the presence of coronary artery spasm. Related names include Kounis syndrome, cardiac allergy, cardiac urticaria, allergic myocarditis and the like. Conclusion: Allergic reactions can cause coronary artery spasm or thrombosis, leading to ACS. Shock is not the only pathogenesis. Related names to be unified.