Nakagomi Daiki, Cousins Claire, Sznajd Jan, Furuta Shunsuke, Mohammad Aladdin J, Luqmani Raashid, Jayne David
Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Clin Exp Rheumatol. 2017 Mar-Apr;35 Suppl 103(1):139-145. Epub 2017 Mar 13.
Outcome assessment in large-vessel vasculitis (LVV) remains challenging and this impairs patient management and the conduct of clinical studies. Previous proposals for outcome tools have not included imaging. This study aimed to develop an imaging score to quantify damage in LVV and to assess the difference between Takayasu (TAK) and giant cell arteritis (GCA).
Ninety-six patients (41 TAK, 55 GCA) were identified from local registries at two University Hospitals in the UK. Radiologic lesions including stenosis, occlusion and aneurysm were evaluated in 25 arterial regions by enhanced computed tomography or magnetic resonance angiography. Lesion correlation with combined damage assessment scores was employed in a multiple regression analysis to define the weight of individual lesions and develop a damage index.
A numerical damage index was developed: the "Combined Arteritis Damage Score (CARDS)". The index was derived from a formula: number of regions with mild stenosis × 0.6 + number of regions with moderate to severe stenosis × 1.2 + number with occlusions × 1.6 + number with aneurysms × 0.8 in 25 arterial regions. The median CARDS was higher in TAK than GCA (4.1 and 0.6, interquartile range 1.3-5.7 and 0-3, p<0.001).
We have developed a damage assessment tool, CARDS, based on imaging in LVV of potential value to clinical studies and patient management. TAK and GCA differ in the radiologic severity of disease.
大血管血管炎（LVV）的疗效评估仍然具有挑战性，这会影响患者管理和临床研究的开展。以往关于疗效评估工具的提议未纳入影像学检查。本研究旨在开发一种影像学评分系统，以量化LVV中的损伤情况，并评估高安动脉炎（TAK）和巨细胞动脉炎（GCA）之间的差异。
从英国两家大学医院的本地登记处识别出96例患者（41例TAK，55例GCA）。通过增强计算机断层扫描或磁共振血管造影对25个动脉区域的放射学病变（包括狭窄、闭塞和动脉瘤）进行评估。在多元回归分析中采用病变与综合损伤评估评分的相关性来确定各个病变的权重，并制定损伤指数。
开发了一个数值损伤指数：“联合动脉炎损伤评分（CARDS）”。该指数由一个公式得出：25个动脉区域中轻度狭窄区域数×0.6 + 中度至重度狭窄区域数×1.2 + 闭塞区域数×1.6 + 动脉瘤区域数×0.8。TAK患者的CARDS中位数高于GCA患者（分别为4.1和0.6，四分位间距为1.3 - 5.7和0 - 3，p<0.001）。
我们基于LVV的影像学检查开发了一种具有潜在临床研究和患者管理价值的损伤评估工具CARDS。TAK和GCA在疾病的放射学严重程度方面存在差异。
