Does this patient have temporal arteritis?
Does this patient have temporal arteritis?
复制标题
DOI：
10.1001/jama.287.1.92
复制
发表时间：
2002-01-02
影响因子：
120.7
通讯作者：
Shmerling, RH
中科院分区：
文献类型：
--
作者：
Smetana, GW;Shmerling, RH
背景临床医生必须能够自信地诊断颞动脉炎 (TA)，因为未能做出正确的诊断可能会导致不可逆的视力丧失以及对头痛、疲劳和其他潜在症状的评估和治疗不当。疑似 TA 患者中特定体征和症状的诊断价值尚不清楚。 目的 确定历史特征、体格检查和红细胞沉降率 (ESR) 在诊断 TA 中的准确性。 数据来源 我们对 1966 年 1 月至 2000 年 7 月期间发表的英文文章进行了 MEDLINE 检索，并对检索到的文章、以前的评论、专着和教科书的参考书目进行了手动检索。 研究选择研究提供了患者的详细临床信息被转诊进行颞动脉活检的人。在检索到的 114 项研究中，有 41 项符合我们的纳入标准； 21 项研究包括活检阳性和活检阴性患者，构成了我们综述的核心。 数据提取 两位作者独立审查了每项研究以确定资格，使用标准化工具提取数据，并使用预定标准对研究质量进行分类。 数据综合 一般人群中 TA 的患病率低于 1%。然而，在我们的 21 项核心研究中，39% 转诊进行颞动脉活检的患者取得了阳性结果。在转诊进行活检的患者中，唯一显着增加 TA 可能性的 2 个历史特征是下颌跛行（阳性似然比 [LR]，4.2；95% 置信区间 [CI]，2.8-6.2）和复视（阳性 LR，3.4；95% CI，1.3-8.6）。不存在任何颞动脉异常是唯一适度降低疾病可能性的临床因素（阴性 LR，0.53；95% CI，0.38-0.75）。预测性体检结果包括颞动脉珠状（LR 阳性，4.6；95% CI，1.1-18.4）、突出（LR 阳性，4.3；95% CI，2.1-8.9）和压痛（LR 阳性，2.6；95% CI，1.9-3.7）。正常的 ESR 值表明疾病的可能性要小得多（异常 ESR 的阴性 LR，0.2；95% CI，0.08-0.51）。 结论 少数临床特征有助于预测临床怀疑疾病的患者颞动脉活检阳性的可能性；最有用的发现是正常的 ESR，这使得 TA 不太可能发生。
Context Clinicians must be able to confidently diagnose temporal arteritis (TA), since failure to make a correct diagnosis may lead to irreversible visual loss as well as inappropriate evaluation and treatment of headache, fatigue, and other potential presenting symptoms. The diagnostic value of particular signs and symptoms among patients with suspected TA is unknown.Objective To determine the accuracy of historical features, physical examination, and erythrocyte sedimentation rate (ESR) in diagnosis of TA.Data Sources We performed a MEDLINE search of English-language articles published between January 1966 and July 2000 and a hand search of bibliographies of retrieved articles, previous reviews, monographs, and textbooks.Study Selection Studies that provided detailed clinical information on patients who had been referred for temporal artery biopsy. Of 114 studies retrieved, 41 met our inclusion criteria; 21 included both biopsy-positive and biopsy-negative patients and formed the core of our review.Data Extraction Both authors independently reviewed each study to determine eligibility, abstracted data using a standardized instrument, and classified study quality using predetermined criteria.Data Synthesis The prevalence of TA in the general population is less than 1%. However, in our 21 core studies, 39% of patients referred for temporal artery biopsy had positive results. The only 2 historical features that substantially increased the likelihood of TA among patients referred for biopsy were jaw claudication (positive likelihood ratio [LR], 4.2; 95% confidence interval [CI], 2.8-6.2) and diplopia (positive LR, 3.4; 95% CI, 1.3-8.6). The absence of any temporal artery abnormality was the only clinical factor that modestly reduced the likelihood of disease (negative LR, 0.53; 95% CI, 0.38-0.75). Predictive physical findings included temporal artery beading (positive LR, 4.6; 95% CI, 1.1-18.4), prominence (positive LR, 4.3; 95% CI, 2.1-8.9), and tenderness (positive LR, 2.6; 95% CI, 1.9-3.7). Normal ESR values indicated much less likelihood of disease (negative LR for abnormal ESR, 0.2; 95% CI, 0.08-0.51).Conclusions A small number of clinical features are helpful in predicting the likelihood of a positive temporal artery biopsy among patients with a clinical suspicion of disease; the most useful finding is a normal ESR, which makes TA unlikely.