Boyev L R, Miller N R, Green W R
Neuro-Ophthalmology Unit, The Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Am J Ophthalmol. 1999 Aug;128(2):211-5. doi: 10.1016/s0002-9394(99)00101-4.
To determine the utility of unilateral versus bilateral temporal artery biopsies in detecting the pathologic changes of giant cell arteritis.
We performed a retrospective study to determine the utility of unilateral versus bilateral temporal artery biopsies in detecting the pathologic changes of giant cell arteritis. The pathologic reports of consecutive temporal artery biopsy specimens received at the Wilmer Ocular Pathology Laboratory over a 28-year period from 1968 to 1996 were reviewed.
Of 908 specimens examined from 758 patients, 300 specimens were simultaneous bilateral biopsies from 150 patients, 72 specimens were bilateral sequential biopsies from 36 patients, and the remaining 536 specimens were unilateral biopsies from 536 patients. Of the 186 patients who had bilateral simultaneous or nonsimultaneous biopsies, 176 had identical diagnoses on both sides. In four patients, no artery was obtained on one side. In each of the remaining six patients, five of whom had bilateral simultaneous biopsies and one of whom had bilateral sequential biopsies performed 8 days apart, the biopsy specimen from one side was interpreted as showing only arteriosclerotic changes with no evidence of active or healed arteritis, whereas the other specimen was interpreted as showing either probable healed arteritis (three specimens) or possible early arteritis (three cases). In none of the six patients with differing diagnoses between the two sides was one side interpreted as showing definite, active giant cell arteritis. Five of the six patients were subsequently determined to have giant cell arteritis, based on a combination of clinical findings, erythrocyte sedimentation rate, and response to treatment with systemic corticosteroids.
The results of this study indicate that performing a bilateral simultaneous or sequential temporal artery biopsy improves the diagnostic yield in at least 3% of cases of giant cell arteritis, whereas in 97% of cases, the two specimens show the same findings. Thus, in patients in whom only one artery can be biopsied, there is a high probability of obtaining the correct diagnosis. Nevertheless, although the improvement in diagnostic yield of bilateral temporal artery biopsies is low, the consequences of both delayed diagnosis and treatment of giant cell arteritis as well as the use of systemic corticosteroids in patients who do not have giant cell arteritis are of such potential severity that consideration should always be given to performing bilateral temporal artery biopsies in patients suspected of having the disease.
确定单侧与双侧颞动脉活检在检测巨细胞动脉炎病理变化中的效用。
我们进行了一项回顾性研究，以确定单侧与双侧颞动脉活检在检测巨细胞动脉炎病理变化中的效用。回顾了1968年至1996年28年间在威尔默眼科病理实验室接收的连续颞动脉活检标本的病理报告。
在对758例患者检查的908份标本中，300份标本是来自150例患者的双侧同时活检，72份标本是来自36例患者的双侧序贯活检，其余536份标本是来自536例患者的单侧活检。在186例进行双侧同时或不同时活检的患者中，176例两侧诊断相同。4例患者一侧未获取到动脉组织。在其余6例患者中，5例进行了双侧同时活检，1例进行了间隔8天的双侧序贯活检，其中一侧的活检标本被解释为仅显示动脉硬化改变，无活动性或愈合性动脉炎证据，而另一侧标本被解释为显示可能的愈合性动脉炎（3份标本）或可能的早期动脉炎（3例）。在两侧诊断不同的6例患者中，无一例一侧被解释为显示明确的活动性巨细胞动脉炎。根据临床发现、红细胞沉降率以及对全身皮质类固醇治疗的反应，6例患者中有5例随后被确定患有巨细胞动脉炎。
本研究结果表明，进行双侧同时或序贯颞动脉活检可使至少3%的巨细胞动脉炎病例的诊断率提高，而在97%的病例中，两份标本显示相同结果。因此对于只能对一侧动脉进行活检的患者，获得正确诊断的可能性很高。然而，尽管双侧颞动脉活检的诊断率提高幅度不大，但巨细胞动脉炎诊断和治疗延迟以及在未患巨细胞动脉炎的患者中使用全身皮质类固醇的后果可能非常严重，因此对于疑似患有该病的患者，应始终考虑进行双侧颞动脉活检。
