Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.
Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
Ann Rheum Dis. 2015 Jan;74(1):129-35. doi: 10.1136/annrheumdis-2013-204113. Epub 2013 Oct 4.
To evaluate the risk of aortic aneurysm in patients with giant cell arteritis (GCA) compared with age-, gender- and location-matched controls.
A UK General Practice Research Database (GPRD) parallel cohort study of 6999 patients with GCA and 41 994 controls, matched on location, age and gender, was carried out. A competing risk model using aortic aneurysm as the primary outcome and non-aortic-aneurysm-related death as the competing risk was used to determine the relative risk (subhazard ratio) between non-GCA and GCA subjects, after adjustment for cardiovascular risk factors.
Comparing the GCA cohort with the non-GCA cohort, the adjusted subhazard ratio (95% CI) for aortic aneurysm was 1.92 (1.52 to 2.41). Significant predictors of aortic aneurysm were being an ex-smoker (2.64 (2.03 to 3.43)) or a current smoker (3.37 (2.61 to 4.37)), previously taking antihypertensive drugs (1.57 (1.23 to 2.01)) and a history of diabetes (0.32 (0.19 to 0.56)) or cardiovascular disease (1.98 (1.50 to 2.63)). In a multivariate model of the GCA cohort, male gender (2.10 (1.38 to 3.19)), ex-smoker (2.20 (1.22 to 3.98)), current smoker (3.79 (2.20 to 6.53)), previous antihypertensive drugs (1.62 (1.00 to 2.61)) and diabetes (0.19 (0.05 to 0.77)) were significant predictors of aortic aneurysm.
Patients with GCA have a twofold increased risk of aortic aneurysm, and this should be considered within the range of other risk factors including male gender, age and smoking. A separate screening programme is not indicated. The protective effect of diabetes in the development of aortic aneurysms in patients with GCA is also demonstrated.
评估巨细胞动脉炎（GCA）患者发生主动脉瘤的风险与年龄、性别和位置匹配对照者相比。
在英国普通实践研究数据库（GPRD）中进行了一项 6999 例 GCA 患者和 41994 例对照者的平行队列研究，根据位置、年龄和性别进行匹配。使用主动脉瘤作为主要结局，非主动脉瘤相关死亡作为竞争风险的竞争风险模型，确定非 GCA 和 GCA 受试者之间的相对风险（亚危险比），并对心血管危险因素进行调整。
与非 GCA 队列相比，GCA 队列的主动脉瘤调整后亚危险比（95%CI）为 1.92（1.52 至 2.41）。主动脉瘤的显著预测因素为曾吸烟者（2.64（2.03 至 3.43））或现吸烟者（3.37（2.61 至 4.37））、既往服用抗高血压药物（1.57（1.23 至 2.01））和糖尿病史（0.32（0.19 至 0.56））或心血管疾病史（1.98（1.50 至 2.63））。在 GCA 队列的多变量模型中，男性（2.10（1.38 至 3.19））、曾吸烟者（2.20（1.22 至 3.98））、现吸烟者（3.79（2.20 至 6.53））、既往抗高血压药物（1.62（1.00 至 2.61））和糖尿病（0.19（0.05 至 0.77））是主动脉瘤的显著预测因素。
GCA 患者发生主动脉瘤的风险增加了两倍，这应考虑到其他风险因素，包括男性、年龄和吸烟。不需要单独的筛查计划。GCA 患者中糖尿病对主动脉瘤发展的保护作用也得到了证实。
