強直性脊椎炎に房室伝導障害を合併した兄弟例

A Case of Brothers Suffering from Ankylosing Spondylitis,who Developed Antrioventricular Conduction Disturbances in Later Years

要旨　強直性脊椎炎の心臓合併症として，房室伝導障害や大動脈弁閉鎖不全症が知られている．今回われわれは，強直性脊椎炎例に房室伝導障害を合併した2症例を経験した．これらの2症例は兄弟であった．70歳の長男は，54歳時にめまいの症状を伴う完全房室ブロックを発現しており，ペースメーカ植込み術を施行している．59歳の三男は，58歳時に狭心症の診断で経皮的冠動脈形成術を施行後，通院中のホルター心電図でWenckebach型2度房室ブロックを認めた．これら2症例には，ともにHLA型判定検査でB-27を認めた．現在までに報告されている強直性脊椎炎の家族内発症例で，房室伝導障害を家族内に複数認めた報告はなかった．今回経験した症例は貴重な症例と考えられた．罹病期間が長期の強直性脊椎炎例では，短期例に比べ心臓合併症の有病率が高いとする報告があり，中年期以降には特に，心臓障害の発現に注意することは重要と考えた．

　As a complication of ankylosing spondylitis, heart disease such as atrioventricular conduction disturbance or aortic insufficiency is known to occur. We encountered two cases that developed atrioventricular conduction disturbance in ankylosing spondylitis. These two cases were brothers. The elder one was 70 years old and he developed third-degree heart block with dizziness at 54 years of age and he was implanted with a pacemaker. The other brother, 59 years old, showed Wenckebach type AV block in a Holter recording after percutaneous transluminal coronary angioplasty for angina pectoris. B-27 on HLA type was found in these two cases. So far, there have been no reports about family members suffering from ankylosing spondylitis and who have developed atrioventricular conduction disturbance. We regarded these cases as invaluable. It was observed that the prevalence of heart disease was higher in cases of ankylosing spondylitis of long duration than in these of short duration. We regard this as an important observation, and urge care lest heart disease develops as a complication in middle-age cases of ankylosing spondylitis.