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单中心主动脉炎的诊断、管理及预后

Diagnosis, Management, and Outcome of Aortitis at a Single Center.

作者信息

Skeik Nedaa, Ostertag-Hill Claire A, Garberich Ross F, Alden Peter B, Alexander Jason Q, Cragg Andrew H, Manunga Jesse M, Stephenson Elliot J, Titus Jessica M, Sullivan Timothy M

机构信息

1 Vascular Medicine, Minneapolis Heart Institute, Minneapolis, MN, USA.

2 Minneapolis Heart Institute Research Foundation, Minneapolis, MN, USA.

出版信息

Vasc Endovascular Surg. 2017 Oct;51(7):470-479. doi: 10.1177/1538574417704296. Epub 2017 Aug 31.

Abstract

BACKGROUND

Aortitis is a rare condition with inflammatory or infectious etiology that can be difficult to diagnose due to the highly variable clinical presentation and nonspecific symptoms. However, current literature on the diagnosis, management, and prognosis of aortitis is extremely scarce.

METHODS

We retrospectively reviewed all patients' charts who were diagnosed with giant cell arteritis, Takayasu arteritis, or noninfectious aortitis presenting at a single center between January 1, 2009, and April 17, 2015. Data collected included demographics, medical history, comorbidities, laboratory and imaging data, management, and outcome.

RESULTS

Among the included 15 patients presenting with aortitis at our center, 53% were diagnosed with Takayasu arteritis, 33% with idiopathic inflammatory aortitis, and 13% with giant cell arteritis. All patients received steroid treatment, 67% received adjunctive immunosuppressants or immunomodulators, and 33% underwent interventional procedures. Based on clinical presentation and laboratory and imaging findings at the last follow-up visit for each patient, 67% showed improvement, 27% had no change in disease activity, and 7% had a progression of the disease.

CONCLUSIONS

Takayasu arteritis was found to be more common than idiopathic inflammatory aortitis and giant cell arteritis among our 15 cases diagnosed with aortitis. All patients received medical therapy and 33% received interventional procedures, leading to 67% improvement of disease activity or related complications. This article also offers a comprehensive review of the diagnosis, management, and outcome of aortitis, supplementing the very limited literature on this disease.

摘要

背景

主动脉炎是一种病因涉及炎症或感染的罕见病症,因其临床表现高度可变且症状不具特异性,故而诊断困难。然而,目前关于主动脉炎的诊断、管理及预后的文献极为匮乏。

方法

我们回顾性分析了2009年1月1日至2015年4月17日期间在单一中心确诊为巨细胞动脉炎、高安动脉炎或非感染性主动脉炎的所有患者病历。收集的数据包括人口统计学信息、病史、合并症、实验室及影像学数据、管理措施及预后情况。

结果

在我们中心纳入的15例主动脉炎患者中,53%被诊断为高安动脉炎,33%为特发性炎性主动脉炎,13%为巨细胞动脉炎。所有患者均接受了类固醇治疗,67%接受了辅助免疫抑制剂或免疫调节剂治疗,33%接受了介入治疗。根据每位患者最后一次随访时的临床表现以及实验室和影像学检查结果,67%的患者病情有所改善,27%的患者疾病活动度无变化,7%的患者病情进展。

结论

在我们诊断的15例主动脉炎病例中,发现高安动脉炎比特发性炎性主动脉炎和巨细胞动脉炎更为常见。所有患者均接受了药物治疗,33%接受了介入治疗,疾病活动度或相关并发症改善率达67%。本文还对主动脉炎的诊断、管理及预后进行了全面综述,补充了关于该疾病极为有限的文献。

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