Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Eur J Clin Invest. 2014;44(3):249-56. doi: 10.1111/eci.12227. Epub 2014 Jan 2.
Vascular endothelial dysfunction and intima-media thickness are characteristic aspects of several vasculitides. We investigated retrospectively the impact of steroid treatment on endothelial dysfunction and intima-media thickness in giant-cell arteritis.
Forty-one patients with giant-cell arteritis (28 female and 13 male) underwent flow-mediated dilatation, a marker of endothelial function, and carotid intima-media thickness within 24 h after diagnosis and 6 months thereafter. Both parameters were investigated in 41 patients of an age- and gender-matched control group.
Brachial flow-mediated dilatation response at baseline was 3.4% (0.2, 8.0) and 1.7% (0.2, 4.8) in giant-cell arteritis patients and control group, respectively. After 6 months treatment, flow-mediated dilatation response was 2.8% (0.4, 4.8) in patients with giant-cell arteritis (P = 0.066) and 1.4% (0.1, 5.5) in the control group (P = 0.741). In contrast, mean carotid intima-media thickness of giant-cell arteritis patients improved significantly between baseline [1.0 mm (0.79, 1.2)] and 6-month follow-up [0.82 mm (0.7, 1.04), P < 0.001]. Subjects with additional symptoms of polymyalgia rheumatica had a notable enlargement of carotid intima-media thickness [1.23 mm (1.14, 2.09)] compared to giant-cell arteritis patients without polymyalgia rheumatica at baseline [0.91 mm (0.76, 1.04), P = 0.001] and 6-month follow-up [1.16 mm (0.80, 1.26) vs. 0.77 mm (0.68, 0.88), P = 0.009].
Steroid therapy has no influence on endothelial function but does significantly improve carotid intima-media thickness in giant-cell arteritis. This divergence of endothelial function and intima-media thickness reflects the specifity of giant-cell arteritis for cerebrovascular arteries thereby sparing the brachial arteries.
血管内皮功能障碍和内中膜厚度是几种血管炎的特征性表现。我们回顾性研究了类固醇治疗对巨细胞动脉炎患者内皮功能障碍和内中膜厚度的影响。
41 例巨细胞动脉炎患者（28 名女性和 13 名男性）在诊断后 24 小时内和 6 个月后接受了血流介导的扩张（一种内皮功能的标志物）和颈动脉内中膜厚度检查。同时对 41 名年龄和性别匹配的对照组患者进行了这两项参数的检查。
巨细胞动脉炎患者基线时肱动脉血流介导的扩张反应分别为 3.4%（0.2，8.0）和 1.7%（0.2，4.8），而对照组分别为 2.8%（0.4，4.8）和 1.4%（0.1，5.5）。治疗 6 个月后，巨细胞动脉炎患者的血流介导的扩张反应为 2.8%（0.4，4.8）（P=0.066），而对照组为 1.4%（0.1，5.5）（P=0.741）。相比之下，巨细胞动脉炎患者的颈动脉内中膜厚度在基线时[1.0mm（0.79，1.2）]和 6 个月随访时[0.82mm（0.7，1.04）]显著改善（P<0.001）。伴有肌痛性风湿症等额外症状的患者，与无肌痛性风湿症的巨细胞动脉炎患者相比，颈动脉内中膜厚度明显增大[基线时为 1.23mm（1.14，2.09）]（P=0.001）和 6 个月随访时[1.16mm（1.04，1.26）比 0.77mm（0.68，0.88）]（P=0.009）。
类固醇治疗对巨细胞动脉炎患者的内皮功能没有影响，但可显著改善颈动脉内中膜厚度。这种内皮功能和内中膜厚度的差异反映了巨细胞动脉炎对脑血管的特异性，从而使肱动脉免受影响。
