HOW DOES PREVIOUS CORTICOSTEROID TREATMENT AFFECT THE BIOPSY FINDINGS IN GIANT-CELL (TEMPORAL) ARTERITIS
HOW DOES PREVIOUS CORTICOSTEROID TREATMENT AFFECT THE BIOPSY FINDINGS IN GIANT-CELL (TEMPORAL) ARTERITIS
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DOI：
10.7326/0003-4819-120-12-199406150-00003
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发表时间：
1994-06-15
影响因子：
39.2
通讯作者：
GABRIEL, SE
中科院分区：
文献类型：
--
作者：
ACHKAR, AA;LIE, JT;GABRIEL, SE
目的：确定既往皮质类固醇治疗对颞动脉活检结果的影响。设计：连续病例系列。地点：三级护理中心。患者：1988 年 1 月 1 日至 1991 年 12 月 31 日期间在明尼苏达州罗切斯特市 Mayo Clinic 进行颞动脉活检的 535 名患者组成的连续队列。测量和结果：颞动脉活检前接受皮质类固醇治疗的剂量和持续时间以及详细的临床和实验室检查数据是从患者的医疗记录中获得的。所有颞动脉活检切片均由不了解临床数据、既往皮质类固醇治疗信息和原始病理诊断的病理学家重新评估。活检标本被分类为动脉炎阴性、典型颞动脉炎阳性或非典型颞动脉炎阳性。活检前未接受皮质类固醇治疗的患者（286 名中的 89 名）和活检前接受皮质类固醇治疗的患者中，35%（249 名中的 86 名）的活检结果呈阳性（P = 0.4；差异的 95% 置信区间为 -4.7% 至 11.5%）。在活检前接受皮质类固醇治疗的患者往往具有更提示动脉炎的临床特征。控制临床和实验室特征差异的多元逻辑回归分析模型表明，活检阳性率与既往皮质类固醇治疗无关。结论：虽然这些结果并不能证明组织学特征不受皮质类固醇的影响，但它们表明，在这个大的连续样本中，未经治疗和皮质类固醇治疗的患者颞动脉活检的阳性率相似。即使在存在活动性疾病的临床指征的情况下，即使皮质类固醇治疗超过 14 天，颞动脉活检也可能显示动脉炎。
Objective: To determine the effect of previous corticosteroid treatment on the results of temporal artery biopsy.Design: Consecutive case series.Setting: Tertiary care center.Patients: A consecutive cohort of 535 patients who had temporal artery biopsies at Mayo Clinic, Rochester, Minnesota, between 1 January 1988 and 31 December 1991.Measurements and Results: The dose and duration of corticosteroid treatment received before temporal artery biopsy and detailed clinical and laboratory data were obtained from the patients' medical records. All temporal artery biopsy slides were re-evaluated by a pathologist blinded to clinical data, previous corticosteroid treatment information, and the original pathologic diagnosis. Biopsy specimens were classified as negative for arteritis, positive for typical temporal arteritis, or positive for atypical temporal arteritis. Biopsy results were positive for 31% of patients (89 of 286) who did not receive corticosteroids before biopsy and for 35% of those (86 of 249) who did receive corticosteroids before biopsy (P = 0.4; 95% confidence interval for the difference, -4.7% to 11.5%). Patients who received corticosteroids before biopsy tended to have clinical features more suggestive of arteritis. A multiple logistic regression analysis model, controlling for these differences in clinical and laboratory features, showed that the biopsy positivity rate was unrelated to previous corticosteroid treatment.Conclusions: Although these results do not prove that histologic features are unaffected by corticosteroids, they show that, in this large, consecutive sample, the positivity rates of temporal artery biopsy were similar in untreated and corticosteroid-treated patients. Temporal artery biopsy may show arteritis even after more than 14 days of corticosteroid therapy in the presence of clinical indications of active disease.