Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: A 16-year overview
Clinical Course, Management, and Outcomes of Pediatric Takayasu Arteritis Initially Presenting With Hypertension: A 16-year overview
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最初表现为高血压的小儿高安动脉炎的临床过程、治疗和结果：16 年概述
DOI：
10.1093/ajh/hpz103
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发表时间：
2019-10-01
影响因子：
3.2
通讯作者：
Lou, Ying
中科院分区：
文献类型：
--
作者：
Fan, Luyun;Zhang, Huimin;Lou, Ying
目的探讨儿童多发性大动脉炎（c-TA）的临床特点、治疗和预后，并对2002年1月至2016年12月期间96例c-TA住院病例进行回顾性分析，2017年1月至2017年12月期间前瞻性招募5例患者。数据进行了比较c-TA组最初表现为高血压和无高血压。通过逻辑回归、Kaplan-Meier生存曲线和考克斯回归模型评估血压（BP）控制、无事件生存期和相关危险因素。结果高血压队列（N = 71，28.2%男性）与非高血压队列相比，活动性疾病明显减少，跛行、晕厥、视力模糊和心肌缺血的发作次数减少;全身症状减少（P < 0.05）。高血压组腹部病变局限性更强（OR = 14.4，P = 0.001），膈上动脉受累有限。肾血管疾病（P = 0.001）和血运重建（P = 0.006）与高血压相关。中位随访3年时，53%的高血压患者血压得到控制，39%的患者发生了包括血管存活在内的事件，其中78.7%的高血压患者血压得到控制（95%CI：65.7%~ 87.2%）、63.0%（95%CI：48.1%~ 74.7%）、48.9%（95%CI：32.0%~ 63.8%）和31.6%（95%CI：13.8%~ 51.2%），均高于非高血压组（P = 0.014）。心力衰竭、中风和体重指数< 18.5 kg/m2是事件的预后因素。干预和基线收缩压是血压控制的独立因素（P < 0.05）。结论大多数c-TA有高血压，表现为静止性疾病，无典型的全身和/或缺血症状，腹部病变更局限，血运重建比例更高，无事件生存率更好。三年血压控制在50%以上。肾动脉介入治疗有利于血压控制和减少不良事件的发生。
BACKGROUNDTo investigate the clinical features, management, and outcomes of childhood Takayasu arteritis (c-TA) initially presenting with hypertension.METHODSThis study retrospectively reviewed medical charts of 96 inpatient c-TA cases from January 2002 to December 2016, with 5 additional patients being prospectively recruited from January 2017 to December 2017. Data were compared between c-TA groups initially presenting with and without hypertension. Blood pressure (BP) control, event-free survival, and associated risk factors were assessed by logistic regression, Kaplan-Meier survival curve, and COX regression models.RESULTSThe hypertensive cohort (N = 71, 28.2% males) as compared with non-hypertensive cohort had significantly fewer active diseases; fewer episodes of claudication, syncope, blurred vision, and myocardial ischemia; and fewer systemic symptoms (P < 0.05). The hypertensive group presented with more localized abdominal lesions (OR = 14.4, P = 0.001) and limited supradiaphragmatic arterial involvement. Renovascular disease (P = 0.001) and revascularization (P = 0.006) were associated with hypertension. At the median 3-year follow-up, 53% of hypertensive patients achieved BP control and 39% experienced events including vascular vival were 78.7% (95% CI: 65.7%-87.2%), 63.0% (95% CI: 48.1%-74.7%), 48.9% (95% CI: 32.0%-63.8%), and 31.6% (95% CI: 13.8%-51.2%), higher than in non-hypertensive group (P = 0.014). Heart failure, stroke, and body mass index < 18.5 kg/m(2) were prognostic factors for events. Intervention and baseline systolic BP were independent factors for BP control (P < 0.05).CONCLUSIONSMajority of c-TA has hypertension, presenting with a more quiescent disease without typical systemic and/or ischemia symptoms, more localized abdominal lesions, higher proportion of revascularizations and better event-free survival. Three-year BP control is more than 50%. Intervention particularly on renal artery is beneficial for BP control and decreased events.