Oculoplastic Surgery, Wills Eye Institute, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2012 Oct;154(4):722-9. doi: 10.1016/j.ajo.2012.03.045. Epub 2012 Jul 17.
To assess the clinical utility of the American College of Rheumatology criteria for the diagnosis of giant cell arteritis (GCA) in patients with positive and negative temporal artery biopsies.
Retrospective case series of all patients undergoing temporal artery biopsy.
Retrospective chart review of all patients seen in the Neuro-ophthalmology Service of the Wills Eye Institute undergoing biopsy. One hundred twelve patients were identified between October 2001 and May 2006. Charts were reviewed for American College of Rheumatology criteria, biopsy results, and progression of visual loss after diagnosis.
Nine of 35 patients (25.7%) with positive biopsies would not have been diagnosed with GCA using American College of Rheumatology criteria alone. An additional 16 patients (45.7%) met only 2 criteria and required the positive biopsy to establish the American College of Rheumatology diagnosis of GCA. Eleven of 39 patients (28.2%) with negative biopsies met the criteria and would have been diagnosed with GCA. Diagnostic agreement between the American College of Rheumatology criteria without biopsy results and biopsy results alone was 51.4%; with the addition of biopsy results to the criteria, this increased to 73.0%.
The current American College of Rheumatology criteria should not be used to diagnose GCA and all patients suspected of having GCA should undergo a temporal artery biopsy.
评估美国风湿病学会（ACR）巨细胞动脉炎（GCA）诊断标准在动脉活检阳性和阴性患者中的临床应用价值。
对所有接受动脉活检的患者进行的回顾性病例系列研究。
对威尔斯眼科研究所神经眼科服务中心接受活检的所有患者进行回顾性图表审查。在 2001 年 10 月至 2006 年 5 月期间，共确定了 112 名患者。对美国风湿病学会标准、活检结果和诊断后视力丧失进展情况进行了图表审查。
35 例阳性活检患者中有 9 例（25.7%）单独使用美国风湿病学会标准不会被诊断为 GCA。另有 16 例患者（45.7%）仅符合 2 项标准，需要阳性活检才能确立美国风湿病学会对 GCA 的诊断。39 例阴性活检患者中有 11 例（28.2%）符合标准，将被诊断为 GCA。没有活检结果和仅活检结果的美国风湿病学会标准之间的诊断一致性为 51.4%；将活检结果添加到标准中后，这一比例增加到 73.0%。
目前的美国风湿病学会标准不应用于诊断 GCA，所有疑似患有 GCA 的患者均应接受颞动脉活检。
