Clinical features, prognosis, and response to treatment in polyarteritis.
Clinical features, prognosis, and response to treatment in polyarteritis.
复制标题
多动脉炎的临床特征、预后和治疗反应。
作者：
R. Cohen;Conn Dl;Ilstrup Dm
对53例随访2年以上的多发性大动脉炎患者的临床资料进行回顾性研究，探讨临床因素和治疗方法对预后的影响。疾病的严重程度各有不同，该组患者的5年生存率为55%。少数患者有持续免疫复合体疾病的证据，如冷球蛋白或乙肝抗原的存在或血清补体减少。这些标记物与不同的临床特征无关，也不影响预后。对预后影响最大的器官受累是肠道和肾脏。8例肠梗死或严重消化道出血患者中6例死亡，10例肾功能不全患者中6例死亡。高血压和周围神经病变不影响预后。36名患者接受了单独使用皮质类固醇的治疗，14名患者接受了皮质类固醇和细胞毒性药物的联合治疗(3名患者没有接受治疗)；两组的结果相同。最后一次看到时，单独使用类固醇的组有22人，联合组有6人还活着。早期死亡通常是由于与脉管炎直接相关的并发症，而晚期死亡通常是由于脑血管或心血管并发症。在最后一次随访中，18名患者处于缓解状态，13名患者患有静止性血管疾病，正在接受维持治疗。
Fifty-three patients with polyarteritis who were followed up for at least 2 years were defined clinically and studied retrospectively to determine the influence of clinical factors and treatment on the prognosis. There was a spectrum of severity of disease, and the 5-year survival in the group was 55%. A small number of patients had evidence of ongoing immune-complex disease, as indicated by the presence of cryoglobulins or hepatitis Bs antigen or by diminished serum complement. These markers were not associated with distinct clinical features and did not influence prognosis. Organ involvement that most adversely affected prognosis was that of the gut and the kidneys. Six of 8 patients with bowel infarction or serious gastrointestinal bleeding died, and 6 of 10 patients with renal insufficiency died. Hypertension and peripheral neuropathy did not influence the prognosis. Thirty-six patients were treated with corticosteroids alone and 14 with a combination of corticosteroids and cytotoxic agents (3 received no treatment); the outcome was the same in both groups. Twenty-two in the steroid-alone group and six in the combination group were alive when last seen. Early deaths were usually due to complications directly related to the vasculitis, and late deaths were often due to cerebrovascular or cardiovascular complications. At the last follow-up, 18 patients were in remission, and 13 had inactive vasculitic disease and were on maintenance treatment.