NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, , Leeds, West Yorkshire, UK.
Ann Rheum Dis. 2014 Jan;73(1):143-8. doi: 10.1136/annrheumdis-2012-202145. Epub 2012 Dec 22.
To review the literature in order to estimate how many previously unknown thoracic aortic aneurysms (TAAs) and thoracic aortic dilatations (TADs) might be detected by systematic, cross-sectional aortic imaging of patients with giant cell arteritis (GCA).
A systematic literature review was performed using Ovid Medline, Embase and the Cochrane Library. Studies potentially relevant to TAA/TAD were evaluated by two authors independently for relevance, bias and heterogeneity. Meta-analysis was performed using a random-effects model to estimate pooled prevalence.
Two analyses of routinely collected administrative data suggested a threefold risk of TAA/dissection in GCA compared with controls. In GCA cohorts without systematic imaging, 2-8% had TAA. In the two best-reported studies, aneurysm dissection/rupture occurred in 1% and 6% of GCA cases. Aortic imaging studies had a variety of TAA/TAD definitions, imaging methods and time points. There were limited data on age-matched controls. Three studies suggested that male sex may be a risk factor for TAA/TAD in GCA. On average, five to ten patients with GCA would need aortic imaging to detect one previously unknown TAA/TAD.
The data support an association between GCA and TAA/TAD compared with age-matched controls, but the true relative risk, and the time course of that risk, remains unclear. It is also unclear whether chest radiography is a sufficiently sensitive screening tool. Clinicians should retain a high index of suspicion for aortic pathology in patients with GCA. Before ordering imaging, clinicians should consider whether, and how, detecting aortic pathology would affect a patient's management.
系统回顾文献，以评估在巨细胞动脉炎（GCA）患者中进行系统性横断面主动脉成像可能会发现多少先前未知的胸主动脉瘤（TAA）和胸主动脉扩张（TAD）。
使用 Ovid Medline、Embase 和 Cochrane 图书馆进行系统文献检索。两位作者独立评估了可能与 TAA/TAD 相关的研究，以评估相关性、偏倚和异质性。使用随机效应模型进行荟萃分析，以估计汇总患病率。
两项常规收集的行政数据的分析表明，与对照组相比，GCA 患者发生 TAA/夹层的风险增加了三倍。在没有系统成像的 GCA 队列中，2-8%的患者存在 TAA。在两项报道最好的研究中，1%和 6%的 GCA 病例发生了动脉瘤夹层/破裂。主动脉成像研究具有各种 TAA/TAD 定义、成像方法和时间点。关于年龄匹配对照的数据有限。三项研究表明，男性可能是 GCA 中 TAA/TAD 的一个危险因素。平均而言，需要对五到十位 GCA 患者进行主动脉成像才能发现一个先前未知的 TAA/TAD。
与年龄匹配的对照组相比，数据支持 GCA 与 TAA/TAD 之间存在关联，但真正的相对风险及其风险的时间进程仍不清楚。胸透是否是一种足够敏感的筛查工具也不清楚。临床医生在治疗 GCA 患者时应保持对主动脉病变的高度怀疑。在进行影像学检查之前，临床医生应考虑是否以及如何检测主动脉病变会影响患者的治疗。
