Gonzalez-Gay Miguel A, Garcia-Porrua Carlos, Piñeiro Angela, Pego-Reigosa Robustiano, Llorca Javier, Hunder Gene G
From Divisions of Rheumatology (MAG-G, CG-P, AP) and Neurology (RP-R), Hospital Xeral-Calde, Lugo, Spain; Division of Preventive Medicine and Public Health (JL), School of Medicine, University of Cantabria, Santander, Spain; and Division of Rheumatology (GGH), Mayo Clinic, Rochester, Minnesota, United States.
Medicine (Baltimore). 2004 Nov;83(6):335-341. doi: 10.1097/01.md.0000145366.40805.f8.
Most classical manifestations of giant cell arteritis (GCA) are the result of occlusive vascular involvement. However, unlike ischemic manifestations, aortic aneurysmal disease in patients with GCA has been less well described. We assessed the incidence and predictors of aortic aneurysm and dissection in patients with biopsy-proven GCA from the Lugo region of northwestern Spain and compared the results with those in a 2003 report from Olmsted County, MN. We performed a retrospective study of biopsy-proven GCA patients diagnosed from 1981 to 2001 at the single hospital for a well-defined population of almost 250,000 people. Twenty (9.5%) of the 210 biopsy-proven GCA patients diagnosed during the study period developed aortic aneurysmal disease. Sixteen of the 20 patients had thoracic aneurysms and 6 had abdominal aneurysms. The incidence of aortic aneurysm and/or dissection in Lugo (18.9 per 1000 person years at risk) was similar to that reported in Olmsted County (18.7 per 1000 person years at risk). Hypertension (hazard ratio: 4.73) and polymyalgia rheumatica with a marked acute inflammatory response at the time of diagnosis of GCA (hazard ratio: 3.71) were the best predictors of aortic aneurysmal disease. Our present observations suggest that a severe inflammatory response associated with hypertension at the time of diagnosis of GCA may promote the development of aortic aneurysmal disease. GCA patients having these features should be monitored for the existence of aortic aneurysm and dissection.
巨细胞动脉炎（GCA）的大多数经典表现是血管闭塞性受累的结果。然而，与缺血性表现不同，GCA患者的主动脉瘤疾病描述较少。我们评估了西班牙西北部卢戈地区经活检证实为GCA的患者中主动脉瘤和夹层的发生率及预测因素，并将结果与明尼苏达州奥尔姆斯特德县2003年的报告进行比较。我们对1981年至2001年在一家医院确诊的经活检证实为GCA的患者进行了回顾性研究，该医院服务于一个近25万人的明确人群。在研究期间确诊的210例经活检证实为GCA的患者中，有20例（9.5%）发生了主动脉瘤疾病。20例患者中有16例患有胸主动脉瘤，6例患有腹主动脉瘤。卢戈地区主动脉瘤和/或夹层的发生率（每1000人年风险为18.9例）与奥尔姆斯特德县报告的发生率（每1000人年风险为18.7例）相似。高血压（风险比：4.73）和在GCA诊断时伴有明显急性炎症反应的风湿性多肌痛（风险比：3.71）是主动脉瘤疾病的最佳预测因素。我们目前的观察结果表明，GCA诊断时与高血压相关的严重炎症反应可能促进主动脉瘤疾病的发展。具有这些特征的GCA患者应监测是否存在主动脉瘤和夹层。
