Department of Systemic Autoimmune Diseases, Hospital Clínic Barcelona, Barcelona, Spain.
Ann Rheum Dis. 2012 Jul;71(7):1170-6. doi: 10.1136/annrheumdis-2011-200865. Epub 2012 Jan 20.
Necroscopic and surgical studies have suggested that giant cell arteritis (GCA) may target the aorta and its main branches. Imaging techniques are able to detect large vessel vasculitis (LVV) non-invasively in patients, but the prevalence of LVV in GCA has not been clearly established.
To assess prospectively the prevalence, characteristics and topography of LVV in patients with newly diagnosed GCA and to determine the associated clinical and laboratory features.
CT angiography (CTA) was performed in 40 consecutive patients with newly diagnosed biopsy-proven GCA. Patients were treatment-naïve or had been treated with corticosteroids for <3 days. Vessel wall thickness and vessel diameter (dilation or stenoses) at four aortic segments (ascending aorta, aortic arch, descending thoracic and abdominal aorta) and at the main aortic branches were evaluated.
LVV was detected in 27 patients (67.5%). The vessels involved were as follows: aorta (26 patients, 65%), brachiocephalic trunk (19 patients, 47.5%), carotid arteries (14 patients, 35%), subclavian arteries (17 patients, 42.5%), axillary arteries (7 patients, 17.5%), splanchnic arteries (9 patients, 22.5%), renal arteries (3 patients, 7.5%), iliac arteries (6 patients, 15%) and femoral arteries (11 patients, 30%). Dilation of the thoracic aorta was already present in 6 patients (15%). Cranial ischaemic events were significantly less frequent in patients with LVV (p=0.029). Treatment-naïve patients had a higher frequency of LVV (77% vs 29%, p=0.005).
CTA-defined LVV occurs in two-thirds of patients with GCA at the time of diagnosis and aortic dilation is already present in 15%. Previous corticosteroid treatment may decrease CTA-detected LVV.
尸检和外科研究表明，巨细胞动脉炎（GCA）可能会累及主动脉及其主要分支。影像学技术能够在患者中无创地检测大动脉血管炎（LVV），但 GCA 中 LVV 的患病率尚未明确。
前瞻性评估新诊断的 GCA 患者中 LVV 的患病率、特征和分布，并确定相关的临床和实验室特征。
对 40 例新诊断的经活检证实的 GCA 连续患者进行 CT 血管造影（CTA）检查。患者为初治或接受皮质类固醇治疗<3 天。评估四个主动脉节段（升主动脉、主动脉弓、降胸主动脉和腹主动脉）和主要主动脉分支的血管壁厚度和血管直径（扩张或狭窄）。
27 例（67.5%）患者发现 LVV。受累血管如下：主动脉（26 例，65%）、头臂干（19 例，47.5%）、颈动脉（14 例，35%）、锁骨下动脉（17 例，42.5%）、腋动脉（7 例，17.5%）、内脏动脉（9 例，22.5%）、肾动脉（3 例，7.5%）、髂动脉（6 例，15%）和股动脉（11 例，30%）。6 例（15%）患者的胸主动脉已有扩张。LVV 患者的颅缺血性事件明显较少（p=0.029）。初治患者 LVV 发生率较高（77%比 29%，p=0.005）。
CTA 定义的 LVV 在诊断时发生在 GCA 患者的三分之二，15%的患者已有主动脉扩张。先前的皮质类固醇治疗可能会减少 CTA 检测到的 LVV。
