Hospital of the University of Pennsylvania, Philadelphia.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Arthritis Rheumatol. 2020 Jul;72(7):1154-1159. doi: 10.1002/art.41233. Epub 2020 Jun 5.
Distinguishing aortitis-induced aneurysms from noninflammatory aortic aneurysms is difficult and often incidentally diagnosed on histologic examination after surgical repair. This study was undertaken to examine surgically diagnosed aortitis and identify patient characteristics and imaging findings associated with the disease.
In this case-control study, cases had newly diagnosed, biopsy-proven noninfectious aortitis after open thoracic aortic aneurysm surgical repair. Five controls were matched with cases for year of surgery and lacked significant inflammation on surgical pathology analysis. Data on comorbidities, demographic characteristics, and laboratory and imaging abnormalities prior to surgery were collected. Associations between exposures and outcomes were evaluated using conditional logistic regression. Backward stepwise logistic regression was used to determine factors independently associated with aortitis. Odds ratios (ORs) with 95%confidence intervals (95%CIs) were calculated.
The study included 262 patients (43 patients with aortitis and 219 controls). Patients with aortitis were older at the time of surgery, predominantly female, and less likely to have a history of coronary artery disease (CAD). Multivariable analysis revealed that aortitis was independently associated with an older age at the time of surgery (OR 1.08 [95%CI 1.03-1.13], P < 0.01), female sex (OR 2.36 [95%CI 1.01-5.51], P = 0.04), absence of CAD (OR 6.92 [95%CI 2.14-22.34], P = 0.04), a larger aneurysm diameter (OR 1.74 [95%CI 1.02-2.98], P = 0.04), and arterial wall thickening on imaging (OR 56.93 [95%CI 4.31-752.33], P < 0.01).
Among patients who undergo open surgical repair of an aortic aneurysm, elderly women with no history of CAD who have evidence of other aortic or arterial wall thickening on imaging are more likely to have histologic evidence of aortitis. Patients with these characteristics may benefit from further rheumatologic evaluation.
鉴别由主动脉炎引起的动脉瘤与非炎症性主动脉瘤较为困难，且通常在手术修复后进行组织学检查时偶然诊断。本研究旨在检查手术诊断的主动脉炎，并确定与该疾病相关的患者特征和影像学表现。
在这项病例对照研究中，病例组为接受开放性胸主动脉瘤手术后新诊断的经活检证实的非感染性主动脉炎患者。对照组为 5 名与病例组手术年份匹配且手术病理学分析未见明显炎症的患者。收集了手术前合并症、人口统计学特征、实验室和影像学异常的数据。采用条件逻辑回归评估暴露与结局之间的关联。采用逐步后退逻辑回归确定与主动脉炎独立相关的因素。计算比值比（OR）及其 95%置信区间（95%CI）。
该研究纳入了 262 名患者（43 名主动脉炎患者和 219 名对照组）。主动脉炎患者的手术时年龄较大，主要为女性，且冠心病（CAD）病史较少。多变量分析显示，手术时年龄较大（OR 1.08 [95%CI 1.03-1.13]，P < 0.01）、女性（OR 2.36 [95%CI 1.01-5.51]，P = 0.04）、无 CAD（OR 6.92 [95%CI 2.14-22.34]，P = 0.04）、更大的动脉瘤直径（OR 1.74 [95%CI 1.02-2.98]，P = 0.04）和影像学上的动脉壁增厚（OR 56.93 [95%CI 4.31-752.33]，P < 0.01）与主动脉炎独立相关。
在接受开放性主动脉瘤手术修复的患者中，无 CAD 病史且影像学上有其他主动脉或动脉壁增厚证据的老年女性更有可能有组织学证据的主动脉炎。具有这些特征的患者可能受益于进一步的风湿病评估。
