González-Gay M A, García-Porrúa C, Llorca J, Hajeer A H, Brañas F, Dababneh A, González-Louzao C, Rodriguez-Gil E, Rodríguez-Ledo P, Ollier W E
Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain.
Medicine (Baltimore). 2000 Sep;79(5):283-92. doi: 10.1097/00005792-200009000-00001.
Giant cell (temporal) arteritis (GCA) is the most common systemic vasculitis in Western countries. It involves large and medium-sized vessels with predisposition to the cranial arteries in the elderly. Cranial ischemic complications, in particular permanent visual loss, constitute the most feared aspects of this vasculitis. Although the use of corticosteroids and a higher physician awareness may have contributed to a decrease in the frequency of severe ischemic complications, permanent visual loss is still present in 7%-14% of patients. To investigate further the incidence, trends, and clinical spectrum of visual manifestations in patients with GCA, we examined the features of patients with biopsy-proven GCA diagnosed at the single reference hospital for a defined population in northwestern Spain during an 18-year period. Predictive factors for the development of any visual manifestation, not only permanent visual loss, were also examined. Between 1981 and 1998, 161 patients were diagnosed with biopsy-proven GCA. Visual ischemic complications were observed in 42 (26.1%), and irreversible blindness, mainly due to anterior ischemic optic neuropathy and frequently preceded by amaurosis fugax, was found in 24 (14.9%). Despite a progressive increase in the number of new cases diagnosed, there was not a significant change in the proportion of patients with visual manifestations during the study period (p = 0.37). Patients with visual ischemic complications had lower clinical and laboratory biologic markers of inflammation. Indeed, during the last years of the study, anemia was associated with a very low risk of visual complications. Also, HLA-DRB104-positive patients had visual manifestations more commonly. Patients with other ischemic complications developed irreversible blindness more frequently. The best predictors of any visual complication were HLA-DRB104 phenotype (odds ratio [OR] 7.47) and the absence of anemia at the time of admission (OR for patients with anemia = 0.07). The best predictors of irreversible blindness (permanent visual loss) were amaurosis fugax (OR 12.63) and cerebrovascular accidents (OR 26.51). The present study supports the claim that ocular ischemic complications are still frequent in biopsy-proven GCA patients from southern Europe. The presence of other ischemic complications constitutes an alarm for the development of irreversible blindness. In contrast, a higher inflammatory response may be a protective factor against the development of cranial ischemic events.
巨细胞（颞）动脉炎（GCA）是西方国家最常见的系统性血管炎。它累及大中型血管，好发于老年人的颅动脉。颅缺血性并发症，尤其是永久性视力丧失，是这种血管炎最可怕的方面。尽管使用皮质类固醇以及医生更高的认知度可能有助于降低严重缺血性并发症的发生率，但仍有7%-14%的患者出现永久性视力丧失。为了进一步研究GCA患者视觉表现的发生率、趋势和临床谱，我们检查了西班牙西北部某单一参考医院在18年期间确诊的经活检证实的GCA患者的特征。还研究了任何视觉表现（不仅是永久性视力丧失）发生的预测因素。1981年至1998年期间，161例患者经活检证实患有GCA。42例（26.1%）出现视觉缺血性并发症，24例（14.9%）出现不可逆性失明，主要原因是前部缺血性视神经病变，且常先有一过性黑矇。尽管新诊断病例数逐渐增加，但研究期间有视觉表现的患者比例无显著变化（p = 0.37）。有视觉缺血性并发症的患者炎症的临床和实验室生物学指标较低。事实上，在研究的最后几年，贫血与视觉并发症的风险极低相关。此外，HLA-DRB104阳性患者更常出现视觉表现。有其他缺血性并发症的患者更常发生不可逆性失明。任何视觉并发症的最佳预测因素是HLA-DRB104表型（优势比[OR] 7.47）和入院时无贫血（贫血患者的OR = 0.07）。不可逆性失明（永久性视力丧失）的最佳预测因素是一过性黑矇（OR 12.63）和脑血管意外（OR 26.51）。本研究支持以下观点：在来自南欧的经活检证实的GCA患者中，眼部缺血性并发症仍然很常见。其他缺血性并发症的存在是不可逆性失明发生的警示信号。相反，较高的炎症反应可能是预防颅缺血性事件发生的保护因素。
