Development of aortic aneurysm/dilatation during the followup of patients with giant cell arteritis:: A cross-sectional screening of fifty-four prospectively followed patients
Development of aortic aneurysm/dilatation during the followup of patients with giant cell arteritis:: A cross-sectional screening of fifty-four prospectively followed patients
复制标题
DOI：
10.1002/art.23315
复制
发表时间：
2008-03-15
期刊：
影响因子：
--
通讯作者：
Cid, Maria C.
中科院分区：
文献类型：
--
作者：
Garcia-Martinez, Ana;Hernandez-Rodriguez, Jose;Cid, Maria C.
Objective.巨细胞动脉炎（GCA）可累及主动脉。回顾性研究表明，与一般人群相比，GCA患者的主动脉瘤患病率较高。我们使用一个定义的方案调查了一组经活检证实的GCA患者的主动脉瘤患病率，并评估了持续的低度疾病活动是否与发生主动脉瘤的高风险相关。在中位随访5.4年（范围4.0-10.5年）后，对54例GCA患者（14例男性和40例女性）进行了横断面评价。筛选方案包括胸部X线片、腹部超声扫描和计算机断层扫描（当怀疑主动脉瘤或观察到相对于基线胸部X线片的变化时）。前瞻性记录临床和实验室数据、皮质类固醇需求和复发情况。12例患者（22.2%）有明显的主动脉结构损伤（动脉瘤/扩张），其中5例患者适合手术修复。主动脉瘤/扩张在男性中（50%）比女性更常见（12.5%;相对风险3.5，95%置信区间1.53-8.01，P = 0.007）。在筛选时，与无主动脉结构损伤的患者相比，动脉瘤/扩张患者血清急性期反应物较低，复发率较低，且需要较短的时间停用泼尼松。在GCA患者中存在发生主动脉瘤/扩张的重大风险。我们的数据不支持动脉瘤形成主要是由于持续可检测的疾病活动。其他因素，包括初始损伤或靶组织的特征，也可能决定对主动脉瘤/扩张的易感性。
Objective. Giant cell arteritis (GCA) may involve the aorta. Retrospective studies have demonstrated a higher prevalence of aortic aneurysm among patients with GCA compared with the general population. We investigated the prevalence of aortic aneurysm in a cohort of patients with biopsy-proven GCA using a defined protocol and assessed whether persisting low-grade disease activity is associated with higher risk of developing aortic aneurysm.Methods. Fifty-four patients with GCA (14 men and 40 women) were cross-sectionally evaluated after a median followup of 5.4 years (range 4.0-10.5 years). The screening protocol included a chest radiograph, abdominal ultrasonography scan, and computed tomography scan when aortic aneurysm was suspected or changes with respect to the baseline chest radiograph were observed. Clinical and laboratory data, corticosteroid requirements, and relapses were prospectively recorded.Results. Twelve patients (22.2%) had significant aortic structural damage (aneurysm/dilatation), 5 of them candidates for surgical repair. Aortic aneurysm/dilatation was more frequent among men (50%) than women (12.5%; relative risk 3.5, 95% confidence interval 1.53-8.01, P = 0.007). At the time of screening, patients with aneurysm/dilatation had lower serum acute-phase reactants, lower relapse rate, and needed shorter periods to withdraw prednisone than patients without aortic structural damage.Conclusion. There is a substantial risk of developing aortic aneurysm/dilatation among patients with GCA. Our data do not support that aneurysm formation mainly results from persistent detectable disease activity. Additional factors including characteristics of the initial injury or the target tissue may also determine susceptibility to aortic aneurysm/dilatation.