Department of Angiology, University Hospital Basel, Basel, Switzerland.
Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
Rheumatology (Oxford). 2019 May 1;58(5):792-797. doi: 10.1093/rheumatology/key383.
To assess changes of arterial vessel wall morphology in large vessel GCA patients (LV-GCA) by repeated US.
Patients with LV-GCA on US examination were followed up 6, 12 and 24 months after diagnosis by US of the temporal, vertebral, carotid (common, internal, external), subclavian, axillary, femoral (deep, superficial and common) and popliteal arteries. Clinical and laboratory data were assessed at each visit. Vessel wall thickening was classified as moderate, marked or arteriosclerotic.
A total of 42 patients (26 female) with a median age of 75 years at diagnosis had in median 2 (range 1-3) US follow-up exams. Twenty-eight had both LV and temporal artery involvement and 14 had LV-GCA only. The common carotid, subclavian, axillary, popliteal and/or superficial femoral artery were most commonly involved. Reduction of LV wall thickening occurred in 45% of patients during follow-up, corresponding to 71 of the 284 (25%) initially 'vasculitic' LV segments. In contrast, a reduction of vessel wall thickening in the temporal artery was found in 85% of patients. Of the LVs, the vertebral, axillary, subclavian and deep femoral arteries were most likely to improve. There was no difference in relapses or the received cumulative steroid dose between patients with or without a reduction of vessel wall thickening (temporal artery or LV) during follow-up.
Regression of wall thickening within the LV is significantly less common than in the temporal artery and irrespective of clinical remission. Morphological regression does not seem to be a useful predictor for relapses.
通过重复超声检查评估大动脉巨细胞动脉炎（LV-GCA）患者的动脉血管壁形态变化。
对超声检查诊断为 LV-GCA 的患者，在诊断后 6、12 和 24 个月分别进行颞动脉、椎动脉、颈动脉（颈总、颈内、颈外）、锁骨下动脉、腋动脉、股动脉（股深、股浅和股总）和腘动脉的超声随访。每次就诊时评估临床和实验室数据。将血管壁增厚分为中度、显著或动脉粥样硬化。
共有 42 例（26 例女性）患者在诊断时的中位年龄为 75 岁，中位超声随访检查次数为 2 次（范围 1-3 次）。28 例患者同时存在 LV 和颞动脉受累，14 例患者仅存在 LV-GCA。最常受累的是颈总、锁骨下、腋、腘和/或股浅动脉。在随访过程中，45%的患者 LV 壁增厚减少，对应于 284 个初始“血管炎”LV 节段中的 71 个。相比之下，85%的患者颞动脉壁增厚减少。在 LV 中，椎动脉、腋动脉、锁骨下动脉和股深动脉最有可能改善。在随访期间，无论是否有血管壁增厚（颞动脉或 LV）减少，复发或累积接受的类固醇剂量均无差异。
LV 内壁增厚的消退明显少于颞动脉，且与临床缓解无关。形态学消退似乎不是复发的有用预测指标。
