巨细胞动脉炎相关卒中：一项回顾性多中心病例对照研究。

Giant Cell Arteritis-related Stroke: A Retrospective Multicenter Case-control Study.

作者信息

de Boysson Hubert, Liozon Eric, Larivière Delphine, Samson Maxime, Parienti Jean-Jacques, Boutemy Jonathan, Maigné Gwénola, Martin Silva Nicolas, Ly Kim, Touzé Emmanuel, Bonnotte Bernard, Aouba Achille, Sacré Karim, Bienvenu Boris

机构信息

From the Department of Internal Medicine, and Biostatistics and Clinical Research Unit, and Department of Neurology, Caen University Hospital; University of Caen, Basse Normandie; University of Caen-Normandie, Inserm U919, Caen; Department of Internal Medicine, Limoges University Hospital, Limoges; Department of Internal Medicine, Bichat University Hospital, Paris; Department of Internal Medicine, Dijon University Hospital, Dijon, France.

H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital, and University of Caen, Basse Normandie; E. Liozon, MD, Department of Internal Medicine, Limoges University Hospital; D. Larivière, MD, Department of Internal Medicine, Bichat University Hospital; M. Samson, MD, PhD, Department of Internal Medicine, Dijon University Hospital; J.J. Parienti, MD, PhD, Biostatistics and Clinical Research Unit, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; K. Ly, MD, PhD, Department of Internal Medicine, Limoges University Hospital; E. Touzé, MD, PhD, Department of Neurology, Caen University Hospital, and University of Caen-Normandie, Inserm U919; B. Bonnotte, MD, PhD, Department of Internal Medicine, Dijon University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital, and University of Caen, Basse Normandie; K. Sacré, MD, PhD, Department of Internal Medicine, Bichat University Hospital; B. Bienvenu, MD, PhD, Department of Internal Medicine, Caen University Hospital, and University of Caen, Basse Normandie.

出版信息

J Rheumatol. 2017 Mar;44(3):297-303. doi: 10.3899/jrheum.161033. Epub 2017 Jan 15.

DOI:10.3899/jrheum.161033

PMID:28089985

Abstract

OBJECTIVE

Our aim was to describe patients with giant cell arteritis (GCA)-related stroke and to compare them with a control group of GCA patients without stroke.

METHODS

We created a retrospective multicenter cohort of patients with (1) GCA diagnosed according to the American College of Rheumatology criteria between 1995 and 2015, and (2) stroke occurring at the time of GCA diagnosis or occurring within 4 weeks of starting GCA therapy. The control group consisted of GCA patients without stroke.

RESULTS

Forty patients [21 women (53%), median age 78 (60-91) yrs] with GCA-related stroke were included and were compared with 200 control patients. Stroke occurred at GCA diagnosis in 29 patients (73%), whereas it occurred after diagnosis in 11 patients. Vertebrobasilar territory was involved in 29 patients (73%). Seven patients died within a few hours or days following stroke. Compared with the control group, stroke patients had more ophthalmic ischemic symptoms [25 (63%) vs 50 (25%), p < 0.001]. Conversely, they demonstrated lower biological inflammatory variables [C-reactive protein: 61 (28-185) mg/l vs 99 (6-400) mg/l, p = 0.04] and less anemia [22/37 (59%) vs 137/167 (79%), p = 0.03] than patients without stroke. Multivariate logistic regression revealed that the best predictors for the occurrence of stroke were the presence of ophthalmic ischemic symptoms at diagnosis (OR 5, 95% CI 2.14-12.33, p = 0.0002) and the absence of anemia (OR 0.39, 95% CI 0.16-0.99, p = 0.04).

CONCLUSION

Stroke, especially in the vertebrobasilar territory, is more likely to occur in patients with GCA who experience recent ophthalmic ischemic symptoms and who exhibit low inflammatory variables.

摘要

目的

我们的目的是描述巨细胞动脉炎（GCA）相关卒中患者，并将他们与无卒中的GCA患者对照组进行比较。

方法

我们建立了一个回顾性多中心队列，纳入的患者需满足：（1）根据美国风湿病学会标准于1995年至2015年期间确诊为GCA；（2）在GCA诊断时发生卒中或在开始GCA治疗后4周内发生卒中。对照组由无卒中的GCA患者组成。

结果

纳入了40例GCA相关卒中患者[21例女性（53%），中位年龄78（60 - 91）岁]，并与200例对照患者进行比较。29例患者（73%）在GCA诊断时发生卒中，11例在诊断后发生。29例患者（73%）累及椎基底动脉区域。7例患者在卒中后数小时或数天内死亡。与对照组相比，卒中患者有更多的眼部缺血症状[25例（63%）对50例（25%），p < 0.001]。相反，与无卒中患者相比，他们的生物学炎症指标较低[C反应蛋白：61（28 - 185）mg/l对99（6 - 400）mg/l，p = 0.04]，贫血情况较少[22/37（59%）对137/167（79%），p = 0.03]。多因素逻辑回归显示，卒中发生的最佳预测因素是诊断时存在眼部缺血症状（比值比5，95%可信区间2.14 - 12.33，p = 0.0002）和无贫血（比值比0.39，95%可信区间0.16 - 0.99，p = 0.04）。