Li Jing, Zhu Mengzhu, Li Mengtao, Zheng Wenjie, Zhao Jiuliang, Tian Xinping, Zeng Xiaofeng
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Beijing Department of Rheumatology, Chinese Medicine Hospital in Linyi City, Linyi, Shandong, China.
Medicine (Baltimore). 2016 Jul;95(27):e4069. doi: 10.1097/MD.0000000000004069.
To analyze the causes of death and the related risk factors for in-patients with Takayasu arteritis (TAK) admitted to a referral center of China during 1983 to 2014.The medical charts of 12 deceased TAK patients (10 women, 2 men) were reviewed by two senior rheumatologists. The demographic data, clinical manifestations, angiographic presentations, and the direct causes of death were analyzed retrospectively. Medical records of 40 TAK patients (32 women, 8 men) were selected as controls by age and sex matching method from 81 patients who were sampled isometrically from 810 successively admitted TAK in-patients of the same center during the same period. In addition to the comparison of clinical manifestations between the two groups, binary logistic regression was conducted to explore the related risk factors of mortality of TAK.Twelve patients died at the median age of 33.5 (ranging from 13 to 68 years old). The median survival time was 102.5(ranging from 6 to 567) months. The direct causes of death were heart failure in 5 (5/12, 41.7%), hemorrhage in 2 (2/12, 16.7%), pulmonary infection in 2 (2/12, 16.7%), sudden death in 1 (1/12, 8.3%), postoperative complication in 1 (1/12, 8.3%), and end-stage malignancy in 1 (1/12, 8.3%). Ischemia (4/12, 33.3%) and hemorrhage (4/12, 33.3%) were the two most common presentations in deceased patients. Eight patients had received surgical procedures related to TAK changes. Among them, 2 patients died after surgical procedure, the other 6 patients died later of non-operation-related causes. Compared with the control group (n = 40), patients in the deceased group had longer disease duration (P = 0.017), higher proportion of active disease (P = 0.020), secondary hypertension (P = 0.004), and congestive heart failure (P = 0.017). A model of binary logistic regression had revealed that secondary hypertension (odds ratio [OR] = 9.333, 95% confidence interval [CI]: 1.721 - 50.614, P = 0.010), congestive heart failure (OR = 5.667, 95% CI: 1.248 - 25.734, P = 0.025), and longer disease duration (OR = 1.007, 95% CI: 1.001 - 0.735, P = 0.027) were risk factors for TAK mortality. Active disease (OR = 0.167, 95% CI: 0.038 - 50.614, P = 0.018) was negatively associated with death of TAK.Heart failure is the leading cause of death in TAK patients, followed by ischemia and pulmonary infection. Early deaths occur postoperatively but become rare later after the procedure. Well-control of hypertension, and prevention of congestive heart failure may improve the long-term prognosis.
分析1983年至2014年期间入住中国某转诊中心的大动脉炎（TAK）住院患者的死亡原因及相关危险因素。两名资深风湿病学家回顾了12例死亡TAK患者（10名女性，2名男性）的病历。对人口统计学数据、临床表现、血管造影表现及直接死亡原因进行回顾性分析。通过年龄和性别匹配方法，从同期该中心810例连续入院的TAK住院患者等距抽样的81例患者中选取40例TAK患者（32名女性，8名男性）的病历作为对照。除比较两组间的临床表现外，进行二元逻辑回归以探讨TAK死亡的相关危险因素。12例患者死亡，中位年龄为33.5岁（范围13至68岁）。中位生存时间为102.5个月（范围6至567个月）。直接死亡原因包括心力衰竭5例（5/12，41.7%）、出血2例（2/12，16.7%）、肺部感染2例（2/12，16.7%）、猝死1例（1/12，8.3%）、术后并发症1例（1/12，8.3%）、终末期恶性肿瘤1例（1/12，8.3%）。缺血（4/12，33.3%）和出血（4/12，33.3%）是死亡患者中最常见的两种表现。8例患者接受了与TAK病变相关的手术。其中，2例患者术后死亡，另外6例患者后来死于非手术相关原因。与对照组（n = 40）相比，死亡组患者病程更长（P = 0.017）、疾病活动比例更高（P = 0.020）、继发性高血压（P = 0.004）和充血性心力衰竭（P = 0.017）。二元逻辑回归模型显示，继发性高血压（比值比[OR] = 9.333，95%置信区间[CI]：1.721 - 50.614，P = 0.010）、充血性心力衰竭（OR = 5.667，95% CI：1.248 - 25.734，P = 0.025）和更长的病程（OR = 1.007，95% CI：1.001 - 0.735，P = 0.027）是TAK死亡的危险因素。疾病活动（OR = 0.167，95% CI：0.038 - 50.614，P = 0.018）与TAK死亡呈负相关。心力衰竭是TAK患者死亡原因之首，其次是缺血和肺部感染。早期死亡发生在术后，但术后后期变得罕见。良好控制高血压及预防充血性心力衰竭可能改善长期预后。
