Delaval Laure, Goulenok Tiphaine, Achouh Paul, Saadoun David, Gaudric Julien, Pellenc Quentin, Kahn Jean-Emmanuel, Pasi Nicoletta, van Gysel Damien, Bruneval Patrick, Papo Thomas, Sacre Karim
Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
Département de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
J Vasc Surg. 2017 Jul;66(1):209-215. doi: 10.1016/j.jvs.2016.11.045. Epub 2017 Feb 21.
Aortitis is an exceedingly rare manifestation of tuberculosis. We describe 11 patients with tuberculous aortitis (TA).
Multicenter medical charts of patients hospitalized between 2003 and 2015 with TA in Paris, France, were reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. TA was considered when aortitis was diagnosed in a patient with active tuberculosis.
Eleven patients (8 women; median age, 44.6 years) with TA were identified during this 12-year period. No patient had human immunodeficiency virus infection. Tuberculosis was active in all cases, with a median delay of 18 months between the first symptoms and diagnosis. At disease onset, vascular signs were mainly claudication, asymmetric blood pressure, and diminished distal pulses. Constitutional symptoms or extravascular signs were present in all patients at some point. Aortic pseudoaneurysm was the most frequent lesion, but three patients had isolated inflammatory aortic stenosis. TA appeared as extension from a contiguous infection in only three cases. Tuberculosis was considered because of clinical features, tuberculin skin or QuantiFERON-TB Gold (Quest Diagnostics, Madison, NJ) test results, pathologic findings, and improvement on antituberculosis therapy. A definite Mycobacterium tuberculosis identification was made in only three cases. All patients received antituberculosis therapy for 6 to 12 months. Surgery including Bentall procedures, aortic bypass, and open abdominal aneurysm repair was performed at diagnosis in eight patients. Seven patients received steroids as an adjunct therapy. All patients clinically improved under treatment. No patients died for a median follow-up duration of 4 years.
TA may result in aneurysms contiguous to regional adenitis but also in isolated inflammatory aortic stenosis. Steroids may be associated with antituberculosis therapy for inflammatory stenotic lesions. Surgery is indicated for aneurysms and in case of worsening stenotic lesions despite anti-inflammatory drugs. No patient died after such combined treatment strategy.
主动脉炎是结核病极为罕见的一种表现形式。我们描述了11例结核性主动脉炎（TA）患者。
回顾了2003年至2015年期间在法国巴黎住院的TA患者的多中心病历。从病历中提取了人口统计学、病史、实验室检查、影像学、病理检查结果、治疗及随访数据。当在患有活动性结核病的患者中诊断出主动脉炎时，即考虑为TA。
在这12年期间共确定了11例TA患者（8名女性；中位年龄44.6岁）。所有患者均无人类免疫缺陷病毒感染。所有病例中的结核病均处于活动期，从首次出现症状到确诊的中位间隔时间为18个月。在疾病发作时，血管症状主要为间歇性跛行、血压不对称和远端脉搏减弱。所有患者在某些时候均出现全身症状或血管外症状。主动脉假性动脉瘤是最常见的病变，但有3例患者出现孤立性炎性主动脉狭窄。仅3例TA表现为邻近感染的蔓延。因临床特征、结核菌素皮肤试验或结核感染T细胞检测（QuantiFERON-TB Gold，凯杰公司，新泽西州麦迪逊）结果、病理检查结果以及抗结核治疗后病情改善而考虑为结核病。仅3例明确鉴定出结核分枝杆菌。所有患者均接受了6至12个月的抗结核治疗。8例患者在诊断时接受了包括Bentall手术、主动脉旁路移植术和开放性腹主动脉瘤修复术在内的手术。7例患者接受了类固醇作为辅助治疗。所有患者在治疗过程中临床症状均有改善。中位随访4年期间，无患者死亡。
TA可能导致与局部腺炎相邻的动脉瘤，也可能导致孤立性炎性主动脉狭窄。对于炎性狭窄病变，类固醇可与抗结核治疗联合使用。对于动脉瘤以及尽管使用了抗炎药物但狭窄病变仍恶化的情况，建议进行手术治疗。采用这种联合治疗策略后无患者死亡。
