Svensson Christina, Eriksson Per, Zachrisson Helene
Department of Clinical Physiology, University Hospital, Linköping, Sweden.
Department of Medicine and Health Science, Division of Clinical Physiology, Linköping University, Linköping, Sweden.
Clin Physiol Funct Imaging. 2020 Jan;40(1):37-45. doi: 10.1111/cpf.12601. Epub 2019 Nov 10.
Takayasu arteritis (TA) is a rare large-vessel arteritis that primarily affects the aorta and its major branches. The aim of this study was to describe the value of high frequency ultrasound for monitoring of inflammatory activity.
Twenty-five patients, range 11-71 years, diagnosed with TA were investigated with duplex ultrasound (DUS) including follow-up studies. Twenty-five healthy controls were also investigated. Nine patients had newly diagnosed active TA. Sixteen patients had stable/inactive disease at baseline DUS, and TA was diagnosed median 4·5 years previously. Intima-media thickness (IMT), vessel and lumen diameter were measured in the carotid arteries, central neck arteries and the aortic arch. The vessel walls were studied qualitatively. The Takayasu ultrasound index was created for inflammatory activity scoring.
Intima-media thickness in common carotid artery (CCA) was (median and 25-75 percentile parenthetic) 2·3 mm (1·7-2·9) in clinically active TA, 1·2 mm (1·1-1·6) in clinically stable TA (P<0·001) and 0·5 mm (0·5-0·6) in healthy controls (P<0·001). Clinically active TA had prominent increase in IMT and/or increased vessel diameter, and/or intramural arteries, and/or hypoechogenic areas interpreted as oedema in the vessel wall. TA in clinical remission was characterized by increased IMT with medium to high echogenicity with or without fibrotic stripes. The Takayasu ultrasound index was higher in patients with active disease versus treated disease, 2·55 (1·60-3·05) versus 1·30 (1·00-1·58), (P = 0·003).
DUS is an excellent tool to monitor inflammatory changes in the vessel wall in TA. Further DUS studies in larger patient populations are warranted.
大动脉炎（TA）是一种罕见的大血管动脉炎，主要累及主动脉及其主要分支。本研究的目的是描述高频超声在监测炎症活动中的价值。
对25例年龄在11至71岁之间、诊断为TA的患者进行了双功超声（DUS）检查，包括随访研究。还对25名健康对照者进行了检查。9例患者为新诊断的活动性TA。16例患者在基线DUS时病情稳定/非活动，TA诊断时间中位数为4.5年。测量颈动脉、颈部中央动脉和主动脉弓的内膜中层厚度（IMT）、血管和管腔直径。对血管壁进行定性研究。创建了大动脉炎超声指数用于炎症活动评分。
临床活动性TA患者颈总动脉（CCA）的内膜中层厚度（中位数及四分位数间距）为2.3 mm（1.7 - 2.9），临床稳定TA患者为1.2 mm（1.1 - 1.6）（P < 0.001），健康对照者为0.5 mm（0.5 - 0.6）（P < 0.001）。临床活动性TA患者的IMT显著增加和/或血管直径增加，和/或壁内动脉，和/或被解释为血管壁水肿的低回声区。临床缓解期的TA表现为IMT增加，回声中等至高，有或无纤维化条纹。活动性疾病患者的大动脉炎超声指数高于治疗后疾病患者，分别为2.55（1.60 - 3.05）和1.30（1.00 - 1.58），（P = 0.003）。
DUS是监测TA血管壁炎症变化的优秀工具。有必要对更多患者进行进一步的DUS研究。
