巨细胞动脉炎复发和对糖皮质激素依赖的相关因素。
Factors Associated with Relapse and Dependence on Glucocorticoids in Giant Cell Arteritis.
机构信息
From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.
A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital.
出版信息
J Rheumatol. 2020 Jan;47(1):108-116. doi: 10.3899/jrheum.181127. Epub 2019 Mar 15.
OBJECTIVE
To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant cell arteritis (GCA).
METHODS
We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses.
RESULTS
The 326 patients (73% women) were followed up for 62 (12-262) months. During followup, 171 (52%) patients relapsed, including 113 (35%) who developed GC dependence. Relapsing patients had less history of stroke (p = 0.01) and presented large-vessel vasculitis (LVV) more frequently on imaging (p = 0.01) than patients without relapse. During the first months, therapeutic strategy did not differ among relapsing and nonrelapsing patients. GC-dependent patients were less likely to have a history of stroke (p = 0.004) and presented LVV on imaging more frequently (p = 0.005) than patients without GC-dependent disease. In multivariable analyses, LVV was an independent predictive factor of relapse (HR 1.49, 95% CI 1.002-2.12; p = 0.04) and GC dependence (OR 2.19, 95% CI 1.19-4.05; p = 0.01). Conversely, stroke was a protective factor against relapse (HR 0.21, 95% CI 0.03-0.68; p = 0.005) and GC-dependent disease (OR 0.10, 95% CI 0.001-0.31; p = 0.0005). Patients with a GC-dependent disease who received a GC-sparing agent had a shorter GC treatment duration than those without (p = 0.008).
CONCLUSION
In this study, LVV was an independent predictor of relapse and GC dependence. Further prospective studies are needed to confirm these findings and to determine whether patients with LVV require a different treatment approach.
目的
确定巨细胞动脉炎（GCA）患者复发和糖皮质激素（GC）依赖的特征和相关因素。
方法
我们回顾性分析了 326 例至少随访 12 个月的 GCA 连续患者。在多变量分析中确定了与复发和 GC 依赖相关的因素。
结果
326 例患者（73%为女性）随访 62（12-262）个月。随访期间，171 例（52%）患者复发，其中 113 例（35%）出现 GC 依赖。复发患者的中风病史较少（p = 0.01），影像学上更常出现大血管血管炎（LVV）（p = 0.01）。在最初的几个月中，复发和未复发患者的治疗策略没有差异。GC 依赖患者的中风病史较少（p = 0.004），影像学上更常出现 LVV（p = 0.005）。多变量分析中，LVV 是复发（HR 1.49，95%CI 1.002-2.12；p = 0.04）和 GC 依赖（OR 2.19，95%CI 1.19-4.05；p = 0.01）的独立预测因素。相反，中风是复发（HR 0.21，95%CI 0.03-0.68；p = 0.005）和 GC 依赖疾病（OR 0.10，95%CI 0.001-0.31；p = 0.0005）的保护因素。接受 GC 节约剂治疗的 GC 依赖患者的 GC 治疗持续时间短于未接受治疗的患者（p = 0.008）。
结论
在这项研究中，LVV 是复发和 GC 依赖的独立预测因素。需要进一步的前瞻性研究来证实这些发现，并确定是否需要对 LVV 患者采用不同的治疗方法。
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