Department of Ophthalmology, University of Saskatchewan, Saskatoon, Sask.
Department of Ophthalmology, McMaster University, Hamilton, Ont.
Can J Ophthalmol. 2018 Feb;53(1):39-44. doi: 10.1016/j.jcjo.2017.07.019. Epub 2017 Oct 9.
Temporal artery biopsy (TAB) is the gold standard for confirming the diagnosis of giant cell arteritis (GCA) when positive. However, the clinical significance of healed/healing (HH) arterial injury on TAB is not well understood. The purpose of this study was to evaluate the clinical significance of this finding on TAB by determining its association with seromarkers typically predictive of GCA.
Single-centre, retrospective, investigational cohort study.
A total of 385 consecutive TABs for clinical suspicion of GCA between January 2009 and January 2016.
Elevations in erythrocyte sedimentation rate, C-reactive protein, and platelet count were compared between patients with negative TAB, GCA-positive TAB, and HH arterial injury using statistical trend testing. Odds ratios of seromarker elevations for HH arterial injury versus GCA were calculated.
Seventy-six GCA-positive, 69 HH, and 240 negative TABs were identified. Mantel-Haenszel tests of trend indicated that platelets >400 000/µL (p < 0.01), erythrocyte sedimentation rate ≥50 mm/hr (p < 0.01), and C-reactive protein ≥24.5 mg/L (p < 0.01) occurred with intermediate frequency in the HH TAB group. The odds of HH TAB were 3.6 times greater (95% CI 1.5-8.5) with platelets >400 000/µL.
HH arterial injury is a heterogenous group that requires treatment in the appropriate clinical setting. From our study, we found that the HH group is intermediate between GCA-positive and GCA-negative biopsy with respect to serology markers only. Thrombocytosis is an independent predictor of HH TAB. With further studies, this marker may be considered when making treatment decisions. Further studies are required to better understand this entity.
当阳性时，颞动脉活检（TAB）是确诊巨细胞动脉炎（GCA）的金标准。然而，TAB 上愈合/修复（HH）动脉损伤的临床意义尚不清楚。本研究旨在通过确定其与通常预测 GCA 的血清标志物的关系，来评估 TAB 上这种发现的临床意义。
单中心、回顾性、研究队列研究。
2009 年 1 月至 2016 年 1 月期间，因怀疑 GCA 而行 385 例连续 TAB。
使用统计学趋势检验比较血沉、C 反应蛋白和血小板计数升高在 TAB 阴性、GCA 阳性和 HH 动脉损伤患者之间的差异。计算 HH 动脉损伤与 GCA 相比血清标志物升高的比值比。
发现 76 例 GCA 阳性、69 例 HH 和 240 例 TAB 阴性。趋势检验的 Mantel-Haenszel 检验表明，血小板>400000/µL（p<0.01）、血沉≥50mm/hr（p<0.01）和 C 反应蛋白≥24.5mg/L（p<0.01）在 HH TAB 组中发生率中等。血小板>400000/µL 时，HH TAB 的比值比为 3.6 倍（95%CI 1.5-8.5）。
HH 动脉损伤是一组异质性的群体，在适当的临床环境中需要治疗。根据我们的研究，我们发现该组在血清标志物方面仅在 GCA 阳性和 GCA 阴性活检之间处于中间位置。血小板增多症是 HH TAB 的独立预测因子。随着进一步的研究，当做出治疗决策时，可以考虑这个标志物。需要进一步的研究来更好地理解这一实体。
