Northwestern University, Chicago, Illinois.
National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.
Arthritis Care Res (Hoboken). 2022 Jun;74(6):1013-1018. doi: 10.1002/acr.24540. Epub 2022 Apr 2.
In addition to aiding in diagnosis, histopathologic findings from temporal artery biopsy (TAB) specimens in giant cell arteritis (GCA) may be valuable for their associations with clinical features of the disease. This study was undertaken to compare histopathologic findings on TAB with biopsy interpretation and demographic, clinical, and imaging features at time of diagnosis.
Patients with a clinical diagnosis of GCA who had a TAB were selected from an international, multicenter observational cohort of vasculitis. Associations between demographic, clinical, radiographic, and histopathologic features were identified using bivariate testing and multivariate regression modeling.
Of 705 patients with GCA who underwent TAB, 69% had histopathologic evidence of definite vasculitis. Specific histopathologic findings included the presence of giant cells (51%), fragmentation of the internal elastic lamina (41%), intimal thickening (33%), and predominantly mononuclear leukocyte infiltration (32%). Histopathologic interpretation of definite vasculitis was independently associated with giant cells (odds ratio [OR] 151.8 [95% confidence interval (95% CI) 60.2-551.6]), predominantly mononuclear leukocyte infiltration (OR 11.8 [95% CI 5.9-24.9]), and fragmentation of the internal elastic lamina (OR 3.7 [95% CI 1.9-7.4]). A halo sign on temporal artery ultrasound and luminal damage of large arteries on angiography were significantly associated with presence of giant cells (OR 2.6 [95% CI 1.1-6.5] and OR 2.4 [95% CI 1.1-5.2], respectively). Specific histopathologic findings were associated with older age, but no associations were identified with vision loss or other clinical features.
Histopathologic findings in GCA are strongly associated with the clinical diagnosis of GCA but have a limited role in identifying patterns of disease.
除了辅助诊断外，颞动脉活检（TAB）在巨细胞动脉炎（GCA）中的组织病理学发现可能因其与疾病的临床特征的关联而具有价值。本研究旨在比较 TAB 的组织病理学发现与活检解读以及诊断时的人口统计学、临床和影像学特征。
从一个国际多中心血管炎观察队列中选择了临床诊断为 GCA 并接受 TAB 的患者。使用双变量检验和多变量回归模型确定人口统计学、临床、放射学和组织病理学特征之间的关联。
在 705 例接受 TAB 的 GCA 患者中，69%有明确的血管炎组织病理学证据。具体的组织病理学发现包括巨细胞存在（51%）、内弹性膜碎裂（41%）、内膜增厚（33%）和主要单核白细胞浸润（32%）。明确血管炎的组织病理学解读与巨细胞（优势比[OR]151.8[95%置信区间（95%CI）60.2-551.6]）、主要单核白细胞浸润（OR 11.8[95%CI 5.9-24.9]）和内弹性膜碎裂（OR 3.7[95%CI 1.9-7.4]）独立相关。颞动脉超声上的晕环征和血管造影上的大动脉管腔损伤与巨细胞的存在显著相关（OR 2.6[95%CI 1.1-6.5]和 OR 2.4[95%CI 1.1-5.2]）。特定的组织病理学发现与年龄较大相关，但与视力丧失或其他临床特征无关联。
GCA 的组织病理学发现与 GCA 的临床诊断密切相关，但在确定疾病模式方面作用有限。
