| Objective:To analyze the clinical manifestations,serological examination,coronary imaging characteristics,percutaneous coronary intervention,long-term follow-up results and other indicators of coronary heart disease patients with positive syphilis specific antibody tests,and to explore the clinical characteristics of cardiovascular syphilis,so as to deepen the understanding of the disease and provide ideas for the early diagnosis and reasonable treatment of the disease.Methods:9363 patients who were admitted to the cardiovascular department of Northern Jiangsu People's Hospital and diagnosed as coronary heart disease and underwent coronary angiography were selected from January 2015 to December2019.According to certain inclusion criteria and exclusion criteria,90 patients with positive syphilis serological tests were selected,and 180 patients with negative syphilis serological tests at the same time were randomly selected as the control group.The clinical data of the two groups were analyzed.The prognosis of the two groups were followed up.Results:1.The age distribution of 90 coronary heart disease patients with positive syphilis specific antibody tests was between 39 and 86 years old,with an average age of 65.70±9.53 years.71 males(78.9%)were 48-86 years old,with an average age of66.28±9.66 years;19 females(21.1%)were 39-80 years old,with an average age of63.53±8.92 years.The incidence rate of male was higher than that of female.There was no significant difference between the two groups in age,gender,systolic and diastolic blood pressure at admission and past medical history(diabetes,hypertension,hyperlipidemia and smoking history)(P>0.05).2.The clinical manifestations in 90 patients were various.61 cases(67.80%)were diagnosed as unstable angina,8 cases(8.90%)as non ST-elevation myocardial infarction and 21 cases(23.30%)as ST-elevation myocardial infarction.There was no significant difference between the two groups(P>0.05).All 90 patients were positive for syphilis specific antibody tests and negative for HIV antibody tests.Among them,10 patients did not carry out the non-specific treponema pallidum serum test,another 80 patients carried out the serum tests,75 cases(93.8%)were positive,3 cases(3.8%)didnot show specific titer,the remaining titer was 1:1-1:128,including 3 cases(3.8%)of1:1,3 cases(3.8%)of 1:2,9 cases(11.3%)of 1:8,15 cases(18.8%)of 1:16,27 cases(33.8%)of 1:32,12 cases(15.8%)of 1:64,3 cases(3.8%)were 1:128.The incidence of aortic regurgitation in CHD group with positive syphilis specific antibody was significantly higher than that in CHD group(P<0.05),and the diameter of aortic root was significantly larger than that in CHD group(P<0.05).3.The results of coronary angiography showed that in 90 patients,there were 2cases(2.2%)without obvious abnormality,4 cases(4.4%)with left coronary ostium lesions,1 case(1.1%)with right coronary ostium lesions,and no bilateral ostial coronary lesion.There were 10 cases(11.1%)with coronary artery ostial and distal vascular lesions,including 2 cases(2.2%)with two branches and 8 cases(8.9%)with three branches.73 patients(81.1%)had no coronary artery ostial lesion,including 26patients(28.9%)with single vessel disease,25 patients(27.8%)with double vessels disease and 22 patients(24.4%)with three vessels disease.Compared with simple coronary heart disease group,syphilis specific antibody tests positive patients were more likely to have more serious coronary artery lesion,more coronary artery vessels be involved,Gensini score significantly increased,the difference was statistically significant(P<0.05).4.Among 90 patients in the positive group,56 patients(62.2%)underwent coronary stent implantation,10 patients implanted one stent in the lesion of coronary artery ostial,the rest patients implanted stent in other lesions.Two patients(2.2%)with coronary artery disease were treated with coronary artery bypass grafting,three patients(3.3%)with coronary artery disease were not treated with any operation,but were treated with drugs.There were significant differences in the number,length and diameter of stents between the two groups(P<0.05).67 patients(74.4%)returned to the local hospital to complete penicillin treatment after the diagnosis of syphilis;8 patients(8.9%)were treated with penicillin in our hospital,of which 6 patients were treated with full-term treatment,and the other 2 patients were discharged before the completion of treatment.When discharged from the hospital,the serum trust titer decreased,and the clinical performance improved significantly.5.During the follow-up by telephone,in 90 patients,11 patients(12.2%)had heart failure symptoms,16 patients(17.8%)died,14 patients(15.6%)lost the follow-up,20patients(22.2%)readmitted to hospital.Among them,13 patients had reexamination ofcoronary angiography and no progress of vascular disease.2 patients transferred to another hospital for coronary artery bypass grafting and lost the follow-up.5 patients readmitted to hospital due to other system diseases without chest tightness,chest pain,asthma and other discomfort.The prognosis of other 29 patients(32.2%)was good.In addition,two patients with coronary artery bypass grafting,one died after operation,one had a good prognosis;10 patients with stent implantation in the coronary artery ostial lesions had a good prognosis;3 patients with coronary artery ostial lesions but no operation,only drugs conservative treatment,one died,and 2 patients were hospitalized due to heart failure.Compare the results of the two groups,the results showed that patients with positive syphilis specific antibody tests were more likely to have MACE events after discharge(P<0.05).The average follow-up time of all patients was 2.9years.Conclusion:Cardiovascular syphilis is not uncommon in the elderly.Unstable angina is common clinical manifestation of cardiovascular syphilis patients.Echocardiography of cardiovascular syphilis patients shows aortic valve insufficiency and aortic root diameter widening.Coronary angiography showed coronary artery ostial stenosis.Patients with cardiovascular syphilis and coronary heart disease have more serious coronary artery lesion,often involving multiple vessels.Patients with cardiovascular syphilis have complex clinical manifestations.The diagnosis needs to be combined with the history,clinical manifestations,laboratory and imaging examinations,as well as the results of coronary angiography.Percutaneous coronary intervention can be used for the treatment of coronary artery ostial stenosis caused by cardiovascular syphilis.The prognosis of cardiovascular syphilis patients with coronary heart disease is poor. |
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