Dai Xiao-Min, Yin Meng-Meng, Liu Yun, Ma Li-Li, Ying Jun, Jiang Lin-Di
Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Fudan University Library, Shanghai 200032, China.
Chin Med J (Engl). 2020 Apr 20;133(8):975-981. doi: 10.1097/CM9.0000000000000704.
Takayasu arteritis-induced renal arteritis (TARA), commonly seen in Takayasu arteritis (TA), has become one of the main causes of poor prognosis and early mortality in patients with TA. TARA progressing into Takayasu arteritis-induced renal artery stenosis (TARAS), could lead to severe complications including malignant hypertension, cardiac-cerebral vascular disease, and ischemic nephropathy. Since there existed no guidelines on treatments, this study aimed to review the comprehensive treatments for TARA.
We searched systematically in databases including PubMed, Ovid-Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed, from inception to May 2018. Literature selection, data extraction, and statistical analysis were performed.
Eighty-two literatures were recruited focusing on medical treatments (n = 34) and surgical treatments (n = 48). We found that combined medical treatments of glucocorticoids and conventional synthetic disease-modifying anti-rheumatic drugs could reach high rates of remission in patients with TARA, and biological disease-modifying anti-rheumatic drugs were preferred for refractory patients. After remission induction, surgical treatment could help reconstruct renal artery and recover renal function partly. Percutaneous transluminal angioplasty was the first choice for patients with TARAS, while open surgery showed a good long-term survival.
Patients with TARA should benefit both from medical treatments and from surgical treatments comprehensively and sequentially. Multidisciplinary team coordination is recommended especially in patients with severe complications.
高安动脉炎所致肾动脉炎（TARA）常见于高安动脉炎（TA）患者，已成为TA患者预后不良和早期死亡的主要原因之一。TARA进展为高安动脉炎所致肾动脉狭窄（TARAS）可导致包括恶性高血压、心脑血管疾病和缺血性肾病在内的严重并发症。由于目前尚无治疗指南，本研究旨在综述TARA的综合治疗方法。
我们系统检索了包括PubMed、Ovid-Medline、EMBASE、Web of Science、中国知网、万方和中国生物医学文献数据库在内的数据库，检索时间从建库至2018年5月。进行文献筛选、数据提取和统计分析。
共纳入82篇文献，其中聚焦于药物治疗的有34篇，聚焦于手术治疗的有48篇。我们发现，糖皮质激素与传统合成改善病情抗风湿药联合治疗可使TARA患者达到较高的缓解率，而生物改善病情抗风湿药更适合难治性患者。诱导缓解后，手术治疗有助于重建肾动脉并部分恢复肾功能。经皮腔内血管成形术是TARAS患者的首选治疗方法，而开放手术则显示出良好的长期生存率。
TARA患者应全面、序贯地从药物治疗和手术治疗中获益。建议多学科团队协作，尤其是对于有严重并发症的患者。
