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首页> 美国卫生研究院文献>other >Recurrent Myocardial Infarction Despite Normal C-reactive Protein in a Patient with Behcet’s Disease and Compound Heterozygous Methylenetetrahydrofolate Reductase (MTHFR) Mutations (C677T and A1298C)
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Recurrent Myocardial Infarction Despite Normal C-reactive Protein in a Patient with Behcet’s Disease and Compound Heterozygous Methylenetetrahydrofolate Reductase (MTHFR) Mutations (C677T and A1298C)

机译：Behcet病和复合杂合亚甲基四氢叶酸还原酶（MTHFR）突变（C677T和A1298C）患者尽管C反应蛋白正常但复发性心肌梗塞

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A 39-year-old diabetic female with Behcet’s disease presented with acute inferior wall myocardial infarction and underwent successful angioplasty of the occluded circumflex artery with a bare-metal stent (balancing increased the bleeding risk with Behcet's). Other coronary vessels were free of obstructive atherosclerosis. Optimal coronary artery disease (CAD) therapy was commenced, and Behcet’s disease treatment was intensified with the normalization of C-reactive protein. Two years later, she presented with an acute left anterior descending artery occlusion that was managed with a drug-eluting stent this time. There was no evidence of diffuse atherosclerosis on coronary angiogram or coronary calcifications on the chest computed tomography (CT) scan. Compound heterozygous methylenetetrahydrofolate reductase (MTHFR) mutations (C677T and A1298C) and high-normal plasma homocysteine were detected. With the long-term continuation of dual anti-platelet, lipid-lowering, immunosuppressive, and folic-acid therapies, she did not have cardiac events during the three-year follow-up. This is the first report of recurrent thrombotic acute coronary syndrome (ACS) in a patient with diabetes, compound heterozygous MTHFR mutations, Behcet’s disease with normal C-reactive protein (CRP), and no evidence of diffuse coronary artery disease.
机译：一名39岁的患有Behcet病的糖尿病女性，表现为急性下壁心肌梗塞，并使用裸金属支架成功地成功完成了对回旋支动脉的血管成形术（平衡增加了Behcet的出血风险）。其他冠状动脉无阻塞性动脉粥样硬化。开始了最佳的冠状动脉疾病（CAD）治疗，并通过C反应蛋白的标准化加强了Behcet的疾病治疗。两年后，她出现了急性左前降支动脉闭塞症，这次用药物洗脱支架治疗。在冠状动脉造影上没有弥散性动脉粥样硬化的证据，在胸部计算机断层扫描（CT）扫描中没有证据显示冠状动脉钙化。检测到复合杂合亚甲基四氢叶酸还原酶（MTHFR）突变（C677T和A1298C）和血浆高半胱氨酸正常水平。由于长期持续采用双重抗血小板，降脂，免疫抑制和叶酸疗法，在三年的随访期间，她没有发生心脏事件。这是糖尿病患者，复合杂合的MTHFR突变，具有正常C反应蛋白（CRP）的白塞病的复发性血栓性急性冠状动脉综合征（ACS）的首次报道，尚无弥漫性冠状动脉疾病的证据。

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