Hill Catherine L, Black Rachel J, Nossent Johannes C, Ruediger Carlee, Nguyen Leanne, Ninan Jem V, Lester Susan
Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia; Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville South, Australia.
Discipline of Medicine, University of Adelaide, Adelaide, Australia; Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia; Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville South, Australia.
Semin Arthritis Rheum. 2017 Feb;46(4):513-519. doi: 10.1016/j.semarthrit.2016.08.015. Epub 2016 Aug 25.
Previous studies of mortality associated with GCA have shown conflicting results. We conducted a systematic review and meta-analysis to determine the mortality risk in GCA patients compared to the general population.
We searched for published studies indexed in MEDLINE and EMBASE and the Cochrane database from inception to June 18, 2015 using the terms "giant cell arteritis" and "temporal arteritis" combined with the terms for death, mortality, and survival. A manual search of citations from retrieved articles was also performed. The inclusion criteria were as follows: (1) observational studies of mortality in GCA and (2) comparison of mortality to the general population. Studies published only in abstract form were excluded. Study eligibility and quality (Newcastle-Ottawa scale) were independently assessed by at least two investigators. Random effects meta-analysis of the mortality ratio (MR) was performed by the inverse variance method.
Out of 435 potentially relevant articles, 64 studies were reviewed, 19 studies were included in the review and 17 studies were included in the meta-analysis. Mortality was not increased in GCA patients ascertained from a population base (MR = 1.03, 95% CI: 0.96-1.10), but was increased in patients ascertained from a hospital setting (MR = 1.61, 95% CI: 1.19-2.19). There was no difference in MR by gender, and two studies provided evidence that mortality was increased in the early years following diagnosis.
At a population level, long-term mortality is not increased in GCA. However, mortality risk may be increased in some patients, and may vary over time.
既往关于巨细胞动脉炎（GCA）相关死亡率的研究结果相互矛盾。我们进行了一项系统评价和荟萃分析，以确定GCA患者与普通人群相比的死亡风险。
我们检索了MEDLINE、EMBASE和Cochrane数据库中从创建至2015年6月18日发表的研究，检索词为“巨细胞动脉炎”和“颞动脉炎”，并结合死亡、死亡率和生存等词。还对检索到的文章的参考文献进行了手工检索。纳入标准如下：（1）GCA死亡率的观察性研究；（2）与普通人群的死亡率比较。仅以摘要形式发表的研究被排除。研究的纳入资格和质量（纽卡斯尔-渥太华量表）由至少两名研究者独立评估。采用逆方差法对死亡率比（MR）进行随机效应荟萃分析。
在435篇可能相关的文章中，64项研究接受了综述，19项研究纳入综述，17项研究纳入荟萃分析。基于人群确定的GCA患者死亡率未增加（MR = 1.03，95%CI：0.96 - 1.10），但基于医院确定的患者死亡率增加（MR = 1.61，95%CI：1.19 - 2.19）。按性别划分的MR无差异，两项研究提供证据表明诊断后的最初几年死亡率增加。
在人群水平上，GCA患者的长期死亡率未增加。然而，部分患者的死亡风险可能增加，且可能随时间变化。
