原発性抗リン脂質抗体症候群と考えられた若年性心筋梗塞の1例

A Case of Acute Myocardial Infarction in a Young Woman with Primary Anti-phospholipid Antibody Syndrome

　患者は26歳，女性．習慣性流産，経口避妊薬服用歴なし．家族性高コレステロール血症なし．生来健康，著患なし．1999年9月16日，テレビゲームをしている際に突然胸部不快感とともにふらつきを自覚し，救急来院した．来院時の心電図では完全房室ブロックを認め，II, IIL aVF誘導で軽度STの上昇およびI,aVLでSTの低下を認め，急性心筋梗塞症を疑い緊急心臓カテーテル検査を施行した．心臓カテーテル検査の結果，右冠動脈入口部に99％の狭窄および血栓像を認めた．このため，3.25mmのバルーンを用いてPTCA（percutaneous transluminal coronary angioplasty）を施行し病変部はほぼ0％まで開大し，終了した．以後，特に問題なく経過し，3週間後の確認造影では再狭窄を認めなかった．ループスアンチコアグラント陽性で他の膠原病の合併もなかったことより，原発性抗リン脂質抗体症候群と考えられた急性心筋梗塞症の1例を経験したので報告する．

A 26-year-old woman was admitted to our center,with complaints of chest discomfort and faintness.Consciousness level was high. Electrocardiogramrevealed complete atrio-ventricular block with slightlyconcave ST elevation in limb leads. Ultrasonographyshowed hypokinesis of the inferior wall. Consideringthese observation, we were led to suspect acute inferiormyocardial infarction. Consequently, we performed cor-onary angiography, which indicated right coronaryostial 99 % stenosis and thrombosis. The left coronaryartery was intact. PTCA was perfomed for the rightcoronary ostium, culminating in adequate dilatation ofthe lesion. The blood Lupus-anticoagulant was detectedwithout any other collagen diseases. Three weeks later,the coronary angiogram showed no restenosis, while theleft coronary ventriculogram disclosed hypokinesis ofthe inferior wall. In this report, we deal with a rare caseof acute myocardial infarction in a young womanpresenting with primary anti-phospholipid antibodysyndrome.