Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo.
Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP.
Reumatismo. 2020 Jul 23;72(2):103-110. doi: 10.4081/reumatismo.2020.1277.
Vessel imaging in Takayasu arteritis (TAK) is often performed in clinical practice following laboratory test abnormalities or clinical symptoms, such as limb claudication. Conversely, the association between limb claudication and vessel imaging manifestations has not been assessed. This observational, cross-sectional study analyzed 139 adult TAK patients from 2000 to 2018. Their arterial vessel imaging information (especially significant stenosis and occlusion data) was registered and crosschecked with clinical and laboratory data. When vessel imaging was performed, the median age and disease duration of the patients were 38 (27.3-47.0) and 5.0 (1.0-12.0) years, respectively. There was no association between arterial abnormalities and demographic data, constitutional symptoms or laboratory parameters. Limb claudication was reported in 42 patients (30.2%): 17.3% reported it in the upper left limb (ULL), 12.2% reported it in the upper right limb (URL), 12.9% reported it in the lower left limb (LLL), and 12.2% reported it in the lower right limb (LRL). When crossmatched with imaging, both ULL and URL were associated with left vertebral artery stenosis/occlusion, and URL was associated with right iliac artery stenosis/occlusion, but no other association was found. In contrast, both LLL and LRL claudication were associated with infrarenal aortic, left iliac and right iliac artery stenosis/ occlusion (p<0.05). Moreover, the ULL and URL claudication symptoms were significantly associated with each other (p<0.001). Upper limb claudication was associated only with left vertebral artery stenosis/occlusion, whereas the subclavian arteries were not, suggesting that the symptom might not be fully explained by limb ischemia. In contrast, lower limb claudication was associated especially with infrarenal aortic and/or iliac arteries stenosis/occlusion.
在临床实践中，通常在实验室检查异常或出现临床症状（如跛行）后才对巨细胞动脉炎（TAK）患者进行血管成像检查。然而，尚未评估跛行与血管成像表现之间的关系。本观察性、横断面研究分析了 2000 年至 2018 年间的 139 例成年 TAK 患者。记录了他们的动脉血管成像信息（特别是显著狭窄和闭塞数据），并与临床和实验室数据进行了交叉核对。进行血管成像检查时，患者的中位年龄和疾病持续时间分别为 38（27.3-47.0）岁和 5.0（1.0-12.0）年。动脉异常与人口统计学数据、全身症状或实验室参数之间没有关联。有 42 例（30.2%）患者报告有跛行：17.3%报告在上肢左侧跛行（ULL），12.2%报告在上肢右侧跛行（URL），12.9%报告在下肢左侧跛行（LLL），12.2%报告在下肢右侧跛行（LRL）。与影像学检查结果相匹配时，ULL 和 URL 均与左侧椎动脉狭窄/闭塞相关，URL 与右侧髂动脉狭窄/闭塞相关，但未发现其他关联。相比之下，LLL 和 LRL 跛行均与肾下主动脉、左侧髂动脉和右侧髂动脉狭窄/闭塞相关（p<0.05）。此外，ULL 和 URL 跛行症状之间存在显著相关性（p<0.001）。上肢跛行仅与左侧椎动脉狭窄/闭塞相关，而锁骨下动脉则不相关，这表明该症状可能不能完全用肢体缺血来解释。相比之下，下肢跛行与肾下主动脉和/或髂动脉狭窄/闭塞尤其相关。
