Yin Yue, Zhang Yun, Wang Dongmei, Han Xinxin, Chu Xiaotian, Shen Min, Zeng Xuejun
Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing.
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou.
Medicine (Baltimore). 2020 Sep 25;99(39):e22406. doi: 10.1097/MD.0000000000022406.
Giant cell arteritis (GCA) is the most common vasculitis in elderly, with ischemic and constitutional symptoms caused by vascular involvement and systemic inflammation. Early initiation of therapy results in prompt remission, while patients may still experience flares or severe complications during glucocorticoid tapering. This study was to identify the characteristics of Chinese GCA patients with different prognosis.Ninety-one patients diagnosed with GCA in Peking Union Medical College Hospital in the last 20 years were followed up. Those who were lost to follow up or were followed up for less than 1 year were excluded. According to the prognosis, patients were divided into the group of favourable prognosis (patients who sustained disease remission for over 1 year) and unfavorable prognosis (patients who had relapses or severe complications). Clinical data at disease onset and after treatment were collected and analysed between the 2 groups.Thirty-seven patients with favourable prognosis and 40 patients with unfavourable prognosis were admitted into the study. Fever as an onset symptom was less common in favourable group (P=.016). As for presentations of GCA, fever, tenderness and abnormal pulsation of temporal artery and jaw claudication were less frequently observed in patients with favourable prognosis (P=.029, .049, .043, respectively). At onset, medium-size arteries were affected more in unfavorable prognosis group (P = .048), and involvement of branches below the aortic arch were more common in favorable prognosis group (P = .034). Erythrocyte sedimentation rate in group of favourable prognosis were significantly lower after treatment (P = .041). Compared with healthy subjects, GCA patients had increased monocytes and decreased lymphocytes at disease onset (P < .01). Monocyte counts were higher in patients with favourable prognosis at disease onset (P = .043), while no significant differences were seen between the 2 groups after treatment. Lymphocyte counts were lower in patients with unfavourable prognosis (P = .014) after treatment.Complete blood count may reflect the disease status of GCA. Little change in monocyte during treatment and lower lymphocytes after treatment may serve as potential predictors of unfavourable clinical prognosis.
巨细胞动脉炎（GCA）是老年人中最常见的血管炎，因血管受累和全身炎症导致缺血性及全身性症状。早期开始治疗可迅速缓解，但患者在糖皮质激素减量过程中仍可能出现病情复发或严重并发症。本研究旨在确定不同预后的中国GCA患者的特征。
对过去20年在北京协和医院诊断为GCA的91例患者进行随访。排除失访或随访时间不足1年的患者。根据预后情况，将患者分为预后良好组（疾病缓解持续超过1年的患者）和预后不良组（有复发或严重并发症的患者）。收集并分析两组患者发病时及治疗后的临床资料。
37例预后良好的患者和40例预后不良的患者纳入研究。发热作为首发症状在预后良好组中较少见（P = 0.016）。至于GCA的表现，发热、颞动脉压痛及搏动异常和颌部间歇性运动障碍在预后良好的患者中较少见（分别为P = 0.029、0.049、0.043）。发病时，预后不良组中、大动脉受累更多（P = = 0.048），而主动脉弓以下分支受累在预后良好组中更常见（P = 0.034）。治疗后，预后良好组的红细胞沉降率显著降低（P = 0.041）。与健康受试者相比，GCA患者发病时单核细胞增多而淋巴细胞减少（P < < 0.01）。发病时，预后良好的患者单核细胞计数较高（P = 0.043），但治疗后两组间无显著差异。治疗后，预后不良的患者淋巴细胞计数较低（P = 0.014）。
全血细胞计数可反映GCA的疾病状态。治疗期间单核细胞变化不大及治疗后淋巴细胞减少可能是不良临床预后的潜在预测指标。
