Kounis综合征
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摘要
Kounis综合征定义为急性冠状动脉(冠脉)综合征同时伴发一种过敏性变态反应事件。可分为3种类型。Kounis综合征在临床上并不是一个罕见的疾病,是一类已被证实由同类的炎性细胞释放同类的递质的临床疾病,这类递质也可出现在非过敏性原因引起的急性冠脉综合征中。因此,熟悉Kounis综合征的病因、流行病学、发病机制和临床表现,对疾病的诊断、治疗、预防和预后非常重要。
Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event.Three different variants of Kounis syndrome have been defined.Kounis syndrome seems to be not a rare disease but an in frequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology.Therefore,awareness of etiology,epidemiology,pathogenesis and clinical manifestations seem to be important for its prognosis,diagnosis,treatment,prevention.
Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event.Three different variants of Kounis syndrome have been defined.Kounis syndrome seems to be not a rare disease but an in frequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology.Therefore,awareness of etiology,epidemiology,pathogenesis and clinical manifestations seem to be important for its prognosis,diagnosis,treatment,prevention.
引文
[1]KOUNIS N G,ZAVRAS G M.Histamine-induced coronary artery spasm:the concept of allergic angina[J].Br J Clin Pract,1991,45:121-128.
[2]HELBLING A,HURNI T,MUELLER U R,et al.Incidence of anaphylaxis with circulatory symptoms:a study over a 3-year period comprising 940,000inhabitants of the Swiss Canton Bern[J].Clin Exp Allergy,2004,34:285-290.
[3]ABDELGHANY M,SUBEDI R,SHAH S,et al.Kounis syndrome:A review article on epidemiology,diagnostic findings,management and complications of allergic acute coronary syndrome[J].Int J Cardiol,2017,232:1-4.
[4]KOGIAS J S,PAPADAKIS E X,TSATIRIS C G,et al.Kounis syndrome:a manifestation of drug-eluting stent thrombosis associated with allergic reaction to contrast material[J].Int J Cardiol,2010,139:206-209.
[5]BITEKER M,DURAN N E,BITEKER F S,et al.Kounis syndrome secondary to cefuroxime-axetil use in an octogenarian[J].J Am Geriatr Soc,2008,56:1757-1758.
[6]GONZLEZ-DE-OLANO D,GANDOLFO-CANOM,MOHEDANO-VICENTE E,et al.Kounis syndrome following the performance of skin test to amoxicillin[J].Int J Cardiol,2014,174:856-857.
[7]BITEKER M,DURAN N E,BITEKER F S,et al.Allergic myocardial infarction in childhood:Kounis syndrome[J].Eur J Pediatr,2010,169:27-29.
[8]LOPEZ P R,PEIRIS A N.Kounis syndrome[J].South Med J,2010,103:1148-1155.
[9]BITEKER M.A new classification of Kounis syndrome[J].Int J Cardiol,2010,145:553-555.
[10]AKYEL A,MURAT S N,CAY S,et al.Late drug eluting stent thrombosis due to acemetacine:type IIIKounis syndrome:Kounis syndrome due to acemetacine[J].Int J Cardiol,2012,155:461-462.
[11]CHEN J P,HOU D,PENDYALA L,et al.Drug-eluting stent thrombosis:the Kounis hypersensitivityassociated acute coronary syndrome revisited[J].JACC Cardiovasc Interv,2009,2:583-593.
[12]BURKE A P,KOLODGIE F D,ZIESKE A,et al.Morphologic findings of coronary atherosclerotic plaques in diabetics:apostmortem study[J].Arterioscler Thromb Vasc Biol,2004,24:1266-1271.
[13]COOK S,LADICH E,NAKAZAWA G,et al.Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis[J].Circulation,2009,120:391-399.
[14]COPPOLA G,CACCAMO G,BACARELLA D,et al.Vasospastic angina and scombroid syndrome:a case report[J].Acta Clin Belg,2012,67:222-225.
[15]BARBARROJA-ESCUDERO J,RODRIGUEZ-RO-DRIGUEZ M,SANCHEZ-GONZALEZ M J,et al.Anisakis simplex:a new etiological agent of Kounis syndrome[J].Int J Cardiol,2013,167:e187-189.
[16]GULER Y,KALKAN S,ESEN A M.An extremely rare trigger of Kounis syndrome:Actinidia chinensis[J].Int J Cardiol,2014,172:e324-325.
[17]BUBLIN M.Kiwifruit allergies[J].Adv Food Nutr Res,2013,68:321-340.
[18]KAZIM S F,SHAHID M.Losartan associated anaphylaxis and angioneurotic oedema[J].J Pak Med Assoc,2010,60:685-686.
[19]JOSEFSSON J,FRBERT O.Losartan-induced coronary artery spasm[J].BMJ Case Rep,2012,2012:111-115.
[20]TAKAGI S,GOTO Y,HIROSE E,et al.Successful treatment of refractory vasospastic angina with corticosteroids:coronary arterial hyperactivity caused by local inflammation[J].Circ J,2004,68:17-22.
[21]ARSLAN Z,IYISOY A,TAVLASOGLU M.Acute myocardial infarction after prednisolone administration for the treatment of anaphylaxis caused by a wasp sting[J].Cardiovasc J Afr,2013,24:e4-6.
[22]HASEGAWA S,TASHIRO N,MATSUBARA T,et al.A comparison of FcepsilonRI-mediated RAN-TES release from human platelets between allergic patients and healthy individuals[J].Int Arch Allergy Immunol,2001,125Suppl 1:42-47.
[23]GILFILLAN A M,TKACZYK C.Integrated signalling pathways for mast-cell activation[J].Nat Rev Immunol,2006,6:218-230.
[24]CHURCH M K,LEVI-SCHAFFER F.The human mast cell[J].J Allergy Clin Immunol,1997,99:155-160.
[25]BROWN S G.Cardiovascular aspects of anaphylaxis:implications for treatment and diagnosis[J].Curr Opin Allergy Clin Immunol,2005,5:359-364.
[26]MARONE G,DE CRESCENZO G,ADT M,et al.Immunological characterization and functional importance of human heart mast cells[J].Immunopharmacology,1995,31:1-18.
[27]KAARTINEN M,PENTTILA,KOVANEN P T.Accumulation of activated mast cells in the shoulder region of human coronary atheroma,the predilection site of atheromatous rupture[J].Circulation,1994,90:1669-1678.
[28]JEZIORSKA M,MCCOLLUM C,WOOLLEY D E.Mast cell distribution,activation,and phenotype in atherosclerotic lesions of human carotid arteries[J].JPathol,1997,182:115-122.
[29]FASSIO F,ALMERIGOGNA F.Kounis syndrome(allergic acute coronary syndrome):different views in allergologic and cardiologic literature[J].Intern Emerg Med,2012,7:489-495.
[30]NIKOLAIDIS L A,KOUNIS N G,GRADMAN AH.Allergic angina and allergic myocardial infarction:a new twist on an old syndrome[J].Can J Cardiol,2002,18:508-511.
[31]BITEKER M.Current understanding of Kounis syndrome[J].Expert Rev Clin Immunol,2010,6:777-788.
[32]SUN H,MOHRI M,SHIMOKAWA H,et al.Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina[J].J Am Coll Cardiol,2002,39:847-851.
[33]GZQUEZ V,DALMAU G,GAIG P,et al.Kounis syndrome:report of 5cases[J].J Investig Allergol Clin Immunol,2010,20:162-165.
[34]DAUVERGNE C,ARAYA M,ABUFHELE A.Coronary spasm secondary to an allergic reaction or Kounis syndrome:report of one case[J].Rev Med Chil,2009,137:811-814.
[35]KOUNIS N G,SOUFRAS G D,TSIGKAS G,et al.Bioabsorbable stent thrombosis Quo Vadis:is Kounis syndrome still present[J].Int J Cardiol,2014,176:305-306.
[36]MAURI L,HSIEH W H,MASSARO J M,et al.Stent thrombosis in randomized clinical trials of drugeluting stents[J].N Engl J Med,2007,356:1020-1029.
[37]ALMPANIS G C,TSIGKAS G G,KOUTSOJAN-NIS C,et al.Nickel allergy,Kounis syndrome and intracardiac metal devices[J].Int J Cardiol,2010,145:364-365.
[38]KOUNIS N G,HAHALIS G,THEOHARIDES TC.Coronary stents,hypersensitivity reactions,and the Kounis syndrome[J].J Interv Cardiol,2007,20:314-323.
[39]KOUNIS N G.Kounis syndrome should be considered the culprit cause of the most feared stent thrombosis[J].J Am Coll Cardiol,2011,58:885;author reply886-887.
[40]GALLI S J,TSAI M,PILIPONSKY A M.The development of allergic inflammation[J].Nature,2008,454(7203):445-454.
[41]KOUNIS N G,GOUDEVENOS J A.Everolimus-eluting versus paclitaxel-eluting stents[J].Lancet,2010,375(9721):1161;author reply 1161-1162.
[42]LIPPI G,BUONOCORE R,SCHIROSA F,et al.Cardiac troponin I is increased in patients admitted to the emergency department with severe allergic reactions.A case-control study[J].Int J Cardiol,2015,194:68-69.
[43]CHA Y S,KIM H,BANG M H,et al.Evaluation of myocardial injury through serum troponin I and echocardiography in anaphylaxis[J].Am J Emerg Med,2016,34:140-144.
[44]KOUNIS N G.what therefore God hath joined together,let not man put asunder[J].Int J Cardiol,2016,203:960-961.
[45]GOTO K,KASAMA S,SATO M,et al.Myocardial scintigraphic evidence of Kounis syndrome:what is the aetiology of acute coronary syndrome[J].Eur Heart J,2016,37:1157-1160.
[46]WINDECKER S,KOLH P,ALFONSO F,et al.2014ESC/EACTS Guidelines on myocardial revascularization:The Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions(EAPCI)[J].Eur Heart J,2014,35:2541-2619.
[47]KOUNIS N G.Coronary Hypersensitivity Disorder:The Kounis Syndrome[J].Clin Ther,2013,35:563-571.
[48]SIMONS F E,ARDUSSO L R,BILM B,et al.World Allergy Organization anaphylaxis guidelines:summary[J].J Allergy Clin Immunol,2011,127:587-593.e1-22.
[49]ATOUI R,MOHAMMADI S,SHUM-TIM D.Surgical extraction of occluded stents:when stenting becomes a problem[J].Interact Cardiovasc Thorac Surg,2009,9:736-738.
[2]HELBLING A,HURNI T,MUELLER U R,et al.Incidence of anaphylaxis with circulatory symptoms:a study over a 3-year period comprising 940,000inhabitants of the Swiss Canton Bern[J].Clin Exp Allergy,2004,34:285-290.
[3]ABDELGHANY M,SUBEDI R,SHAH S,et al.Kounis syndrome:A review article on epidemiology,diagnostic findings,management and complications of allergic acute coronary syndrome[J].Int J Cardiol,2017,232:1-4.
[4]KOGIAS J S,PAPADAKIS E X,TSATIRIS C G,et al.Kounis syndrome:a manifestation of drug-eluting stent thrombosis associated with allergic reaction to contrast material[J].Int J Cardiol,2010,139:206-209.
[5]BITEKER M,DURAN N E,BITEKER F S,et al.Kounis syndrome secondary to cefuroxime-axetil use in an octogenarian[J].J Am Geriatr Soc,2008,56:1757-1758.
[6]GONZLEZ-DE-OLANO D,GANDOLFO-CANOM,MOHEDANO-VICENTE E,et al.Kounis syndrome following the performance of skin test to amoxicillin[J].Int J Cardiol,2014,174:856-857.
[7]BITEKER M,DURAN N E,BITEKER F S,et al.Allergic myocardial infarction in childhood:Kounis syndrome[J].Eur J Pediatr,2010,169:27-29.
[8]LOPEZ P R,PEIRIS A N.Kounis syndrome[J].South Med J,2010,103:1148-1155.
[9]BITEKER M.A new classification of Kounis syndrome[J].Int J Cardiol,2010,145:553-555.
[10]AKYEL A,MURAT S N,CAY S,et al.Late drug eluting stent thrombosis due to acemetacine:type IIIKounis syndrome:Kounis syndrome due to acemetacine[J].Int J Cardiol,2012,155:461-462.
[11]CHEN J P,HOU D,PENDYALA L,et al.Drug-eluting stent thrombosis:the Kounis hypersensitivityassociated acute coronary syndrome revisited[J].JACC Cardiovasc Interv,2009,2:583-593.
[12]BURKE A P,KOLODGIE F D,ZIESKE A,et al.Morphologic findings of coronary atherosclerotic plaques in diabetics:apostmortem study[J].Arterioscler Thromb Vasc Biol,2004,24:1266-1271.
[13]COOK S,LADICH E,NAKAZAWA G,et al.Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis[J].Circulation,2009,120:391-399.
[14]COPPOLA G,CACCAMO G,BACARELLA D,et al.Vasospastic angina and scombroid syndrome:a case report[J].Acta Clin Belg,2012,67:222-225.
[15]BARBARROJA-ESCUDERO J,RODRIGUEZ-RO-DRIGUEZ M,SANCHEZ-GONZALEZ M J,et al.Anisakis simplex:a new etiological agent of Kounis syndrome[J].Int J Cardiol,2013,167:e187-189.
[16]GULER Y,KALKAN S,ESEN A M.An extremely rare trigger of Kounis syndrome:Actinidia chinensis[J].Int J Cardiol,2014,172:e324-325.
[17]BUBLIN M.Kiwifruit allergies[J].Adv Food Nutr Res,2013,68:321-340.
[18]KAZIM S F,SHAHID M.Losartan associated anaphylaxis and angioneurotic oedema[J].J Pak Med Assoc,2010,60:685-686.
[19]JOSEFSSON J,FRBERT O.Losartan-induced coronary artery spasm[J].BMJ Case Rep,2012,2012:111-115.
[20]TAKAGI S,GOTO Y,HIROSE E,et al.Successful treatment of refractory vasospastic angina with corticosteroids:coronary arterial hyperactivity caused by local inflammation[J].Circ J,2004,68:17-22.
[21]ARSLAN Z,IYISOY A,TAVLASOGLU M.Acute myocardial infarction after prednisolone administration for the treatment of anaphylaxis caused by a wasp sting[J].Cardiovasc J Afr,2013,24:e4-6.
[22]HASEGAWA S,TASHIRO N,MATSUBARA T,et al.A comparison of FcepsilonRI-mediated RAN-TES release from human platelets between allergic patients and healthy individuals[J].Int Arch Allergy Immunol,2001,125Suppl 1:42-47.
[23]GILFILLAN A M,TKACZYK C.Integrated signalling pathways for mast-cell activation[J].Nat Rev Immunol,2006,6:218-230.
[24]CHURCH M K,LEVI-SCHAFFER F.The human mast cell[J].J Allergy Clin Immunol,1997,99:155-160.
[25]BROWN S G.Cardiovascular aspects of anaphylaxis:implications for treatment and diagnosis[J].Curr Opin Allergy Clin Immunol,2005,5:359-364.
[26]MARONE G,DE CRESCENZO G,ADT M,et al.Immunological characterization and functional importance of human heart mast cells[J].Immunopharmacology,1995,31:1-18.
[27]KAARTINEN M,PENTTILA,KOVANEN P T.Accumulation of activated mast cells in the shoulder region of human coronary atheroma,the predilection site of atheromatous rupture[J].Circulation,1994,90:1669-1678.
[28]JEZIORSKA M,MCCOLLUM C,WOOLLEY D E.Mast cell distribution,activation,and phenotype in atherosclerotic lesions of human carotid arteries[J].JPathol,1997,182:115-122.
[29]FASSIO F,ALMERIGOGNA F.Kounis syndrome(allergic acute coronary syndrome):different views in allergologic and cardiologic literature[J].Intern Emerg Med,2012,7:489-495.
[30]NIKOLAIDIS L A,KOUNIS N G,GRADMAN AH.Allergic angina and allergic myocardial infarction:a new twist on an old syndrome[J].Can J Cardiol,2002,18:508-511.
[31]BITEKER M.Current understanding of Kounis syndrome[J].Expert Rev Clin Immunol,2010,6:777-788.
[32]SUN H,MOHRI M,SHIMOKAWA H,et al.Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina[J].J Am Coll Cardiol,2002,39:847-851.
[33]GZQUEZ V,DALMAU G,GAIG P,et al.Kounis syndrome:report of 5cases[J].J Investig Allergol Clin Immunol,2010,20:162-165.
[34]DAUVERGNE C,ARAYA M,ABUFHELE A.Coronary spasm secondary to an allergic reaction or Kounis syndrome:report of one case[J].Rev Med Chil,2009,137:811-814.
[35]KOUNIS N G,SOUFRAS G D,TSIGKAS G,et al.Bioabsorbable stent thrombosis Quo Vadis:is Kounis syndrome still present[J].Int J Cardiol,2014,176:305-306.
[36]MAURI L,HSIEH W H,MASSARO J M,et al.Stent thrombosis in randomized clinical trials of drugeluting stents[J].N Engl J Med,2007,356:1020-1029.
[37]ALMPANIS G C,TSIGKAS G G,KOUTSOJAN-NIS C,et al.Nickel allergy,Kounis syndrome and intracardiac metal devices[J].Int J Cardiol,2010,145:364-365.
[38]KOUNIS N G,HAHALIS G,THEOHARIDES TC.Coronary stents,hypersensitivity reactions,and the Kounis syndrome[J].J Interv Cardiol,2007,20:314-323.
[39]KOUNIS N G.Kounis syndrome should be considered the culprit cause of the most feared stent thrombosis[J].J Am Coll Cardiol,2011,58:885;author reply886-887.
[40]GALLI S J,TSAI M,PILIPONSKY A M.The development of allergic inflammation[J].Nature,2008,454(7203):445-454.
[41]KOUNIS N G,GOUDEVENOS J A.Everolimus-eluting versus paclitaxel-eluting stents[J].Lancet,2010,375(9721):1161;author reply 1161-1162.
[42]LIPPI G,BUONOCORE R,SCHIROSA F,et al.Cardiac troponin I is increased in patients admitted to the emergency department with severe allergic reactions.A case-control study[J].Int J Cardiol,2015,194:68-69.
[43]CHA Y S,KIM H,BANG M H,et al.Evaluation of myocardial injury through serum troponin I and echocardiography in anaphylaxis[J].Am J Emerg Med,2016,34:140-144.
[44]KOUNIS N G.what therefore God hath joined together,let not man put asunder[J].Int J Cardiol,2016,203:960-961.
[45]GOTO K,KASAMA S,SATO M,et al.Myocardial scintigraphic evidence of Kounis syndrome:what is the aetiology of acute coronary syndrome[J].Eur Heart J,2016,37:1157-1160.
[46]WINDECKER S,KOLH P,ALFONSO F,et al.2014ESC/EACTS Guidelines on myocardial revascularization:The Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions(EAPCI)[J].Eur Heart J,2014,35:2541-2619.
[47]KOUNIS N G.Coronary Hypersensitivity Disorder:The Kounis Syndrome[J].Clin Ther,2013,35:563-571.
[48]SIMONS F E,ARDUSSO L R,BILM B,et al.World Allergy Organization anaphylaxis guidelines:summary[J].J Allergy Clin Immunol,2011,127:587-593.e1-22.
[49]ATOUI R,MOHAMMADI S,SHUM-TIM D.Surgical extraction of occluded stents:when stenting becomes a problem[J].Interact Cardiovasc Thorac Surg,2009,9:736-738.