Incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis - A population-based study over 50 years
Incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis - A population-based study over 50 years
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DOI：
10.1002/art.11353
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发表时间：
2003-12-01
影响因子：
--
通讯作者：
Matteson, EL
中科院分区：
文献类型：
--
作者：
Nuenninghoff, DM;Hunder, GG;Matteson, EL
Objective.确定巨细胞动脉炎（GCA）患者大动脉并发症（主动脉瘤、主动脉夹层和/或大动脉狭窄）的发生率和预测因素。对明尼苏达州奥姆斯特德县1950年1月1日至1999年12月31日期间诊断为GCA的所有居民进行了随访。确定了主动脉瘤、主动脉夹层和大动脉狭窄的发病率。评估大动脉并发症的可能预测因素和相关因素。确定了46例大动脉并发症（占队列中168例患者的27%）。其中包括30例（18%）主动脉瘤和/或主动脉夹层事件。在这些病例中，18例（11%）涉及胸主动脉，9例（5%）发生主动脉夹层。有21例（13%）大动脉狭窄。15例患者（9%）发生颈动脉狭窄，6例（4%）发生锁骨下动脉/腋动脉/肱动脉狭窄。1例患者（0.6%）发生归因于GCA的髂/股动脉狭窄。高血压和冠状动脉疾病与主动脉瘤和/或夹层相关（两者P < 0.05）。颅脑症状头痛、头皮压痛、颞动脉异常与大动脉狭窄呈负相关（风险比[HR] 0.10 [95%置信区间（95%CI）0.03-0.35，P < 0.0005]），红细胞沉降率较高（HR 0.80 [95% CI 0.67-0.95，P < 0.05]/10 mm/h）。大动脉并发症在GCA中常见。提高对GCA大动脉并发症的认识，特别是早期发生的主动脉夹层，可能会降低相关死亡率。
Objective. To determine the incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis (GCA).Methods. The cohort of all residents of Olmsted County, Minnesota, in whom GCA was diagnosed between January 1, 1950, and December 31, 1999, was followed up. The incidence of aortic aneurysm, aortic dissection, and large-artery stenosis was determined. Possible predictors and correlates of large-artery complication were assessed.Results. Forty-six incident cases of large-artery complication (representing 27% of the 168 patients in the cohort) were identified. These included 30 incident cases,(18%) of aortic aneurysm and/or aortic dissection. Of these cases, 18 (11%) involved the thoracic aorta, with Aortic dissection developing in 9 (5%). There were 21 incident cases (13%) of large-artery stenosis. Fifteen patients (9%) had incident cervical artery stenosis, and 6 (4%) had incident subclavian/axillary/brachial artery stenosis. One patient (0.6%) had incident iliac/femoral artery stenosis attributable to GCA. Hyperlipidemia and coronary artery disease were associated with aortic aneurysm and/or dissection (P < 0.05 for both). Cranial symptoms (headache, scalp tenderness, abnormal temporal arteries) were negatively associated with large-artery stenosis (hazard ratio [HR] 0.10 [95% confidence interval (95% CI) 0.03-0.35, P < 0.0005]), as was a higher erythrocyte sedimentation rate (HR 0.80 [95% CI 0.67-0.95, P < 0.05] per 10 mm/hour).Conclusion. Large-artery complication is common in GCA. Increased awareness of large-artery complication in GCA, particularly early-occurring aortic dissection, may decrease associated mortality.