Ophthalmology Service, Hospital Universitario Ramón y Cajal, Madrid, España, SpainDepartamento de Cirugía, Facultad de Medicina, Universidad de Alcalá, Madrid, España, SpainInternal Medicine Service, Complejo Hospitalario de Toledo, Toledo, España, SpainPathology Service, Hospital Universitario Ramón y Cajal, Madrid, España, Spain.
Acta Ophthalmol. 2013 Dec;91(8):763-8. doi: 10.1111/j.1755-3768.2012.02505.x. Epub 2012 Aug 31.
To evaluate the positivity rate of temporal artery biopsies (TAB) performed in suspects of giant cell arteritis (GCA) and to study the epidemiological and clinical factors associated to the biopsy result.
A retrospective, multicenter, case-control study was performed, including three hundred and thirty-five patients who underwent TAB for a suspicion of GCA from 2001 to 2010. Clinical, epidemiological and pathology data were recovered from the patients' clinical records. Histologic diagnosis of GCA was made when active inflammation or giant cells were found in the arterial wall.
Eighty-one biopsies (24.2%) were considered positive for GCA. Clinical factors independently associated to TAB result in a logistic regression analysis were temporal cutaneous hyperalgesia (OR = 10.8; p < 0.001), jaw claudication (OR = 4.6; p = 0.001), recent-onset headache (OR = 4.4; p = 0.001), decreased temporal pulse (OR = 2.8; p = 0.02), pain and stiffness in neck and shoulders (OR = 2.3; p = 0.05), unintentional weight loss (OR = 1.33; p = 0.003) and age (OR = 1.085; p = 0.004). Other factors such as length of the surgical specimen (OR = 1.079; p = 0.028) and erythrocyte sedimentation rate (OR = 1.042; p < 0.001) were also statistically significant. The model was accurate (C-index = 0.921), reliable (pHosmer-Lemeshow = 0.733) and consistent in the bootstrap sensitivity analysis. No significant association was detected between TAB result and number of days of previous systemic corticosteroid treatment (p = 0.146). However, an association was observed between TAB result and the total accumulated dose of previous systemic corticotherapy (p = 0.043).
Exhaustive anamnesis and clinical examination remain of paramount importance in the diagnosis of GCA. To improve the yield of TAB, it should be performed specially in older patients with GCA-compatible clinic. TAB could be avoided in patients with an isolated elevation of acute phase reactants, without GCA-compatible clinic.
评估巨细胞动脉炎（GCA）疑似患者行颞动脉活检（TAB）的阳性率，并研究与活检结果相关的流行病学和临床因素。
本研究为回顾性、多中心、病例对照研究，纳入 2001 年至 2010 年间因疑似 GCA 而行 TAB 的 335 例患者。从患者的临床记录中提取临床、流行病学和病理学数据。当动脉壁中发现活动性炎症或巨细胞时，作出 GCA 的组织学诊断。
81 例（24.2%）活检被认为与 GCA 阳性相关。在逻辑回归分析中，与 TAB 结果独立相关的临床因素包括颞部皮肤痛觉过敏（OR = 10.8；p < 0.001）、下颌运动障碍（OR = 4.6；p = 0.001）、新发头痛（OR = 4.4；p = 0.001）、颞动脉搏动减弱（OR = 2.8；p = 0.02）、颈肩部疼痛和僵硬（OR = 2.3；p = 0.05）、非故意体重减轻（OR = 1.33；p = 0.003）和年龄（OR = 1.085；p = 0.004）。其他因素，如手术标本长度（OR = 1.079；p = 0.028）和红细胞沉降率（OR = 1.042；p < 0.001）也具有统计学意义。该模型具有较高的准确性（C 指数= 0.921）、可靠性（pHosmer-Lemeshow = 0.733）和 bootstrap 敏感性分析中的一致性。在 TAB 结果与之前全身皮质激素治疗天数之间未检测到显著相关性（p = 0.146）。然而，在 TAB 结果与之前全身皮质激素治疗累积剂量之间观察到相关性（p = 0.043）。
全面的病史采集和临床检查对于 GCA 的诊断仍然至关重要。为了提高 TAB 的阳性率，应特别针对符合 GCA 临床特征的老年患者进行 TAB。对于无 GCA 临床特征但急性时相反应物升高的患者，可避免 TAB。
