Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Clinic Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.
Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105601. doi: 10.1016/j.jstrokecerebrovasdis.2021.105601. Epub 2021 Jan 23.
The diagnosis of giant cell arteritis (GCA) is based on the presence of clinical and laboratory features. Color-duplex sonography (CDS) may supplant the limited sensitivity of temporal artery biopsy. The aim of our work was to characterize clinical and laboratory findings in patients with positive CDS for GCA.
Retrospective study of all consecutive patients of our center fulfilling American College of Rheumatology criteria for GCA who performed CDS study between 2009-2019. Data on clinical and laboratory features were compared in two groups: with and without halo sign.
Ninety-one patients were included. Temporal halo sign was identified in 46% of patients. Halo sign was more often present in older patients (77 ± 8 vs 73 ± 8 years, p = 0.022), associated with systemic features (58% vs 42%, p = 0.011), higher erythrocyte sedimentation rate (84 ± 26 vs 74 ± 34 mm/hour, p = 0.020), and lower hemoglobin values (10.9 ± 1.5 vs 12.1 ± 1.6 g/dL, p < 0.001). The number of patients under corticosteroids before CDS was higher in the group without halo (62% vs 33%, p = 0.005). Ischemic stroke occurred in 17 patients (19%), 76% in the vertebrobasilar territory, and stroke was associated with vertebral halo sign (p < 0.001).
Halo sign was present in half of our patients. Previous corticosteroids treatment decreased positive CDS findings. Systemic symptoms and laboratory findings are more notorious in halo sign subgroup of patients. Stroke cases in GCA patients disproportionally affected the posterior circulation. Ultrasonography provides information about a more pronounced systemic involvement and a higher risk of major complications.
巨细胞动脉炎（GCA）的诊断基于临床和实验室特征。彩色双功能超声（CDS）可能取代颞动脉活检的有限敏感性。我们的工作旨在描述 CDS 阳性的 GCA 患者的临床和实验室发现。
回顾性研究了我们中心 2009-2019 年间所有符合美国风湿病学会 GCA 标准并进行 CDS 研究的连续患者。比较了两组患者的临床和实验室特征：有和无晕环征。
共纳入 91 例患者。颞动脉晕环征在 46%的患者中被识别出来。晕环征更常见于老年患者（77±8 岁比 73±8 岁，p=0.022），与全身表现相关（58%比 42%，p=0.011），红细胞沉降率更高（84±26 毫米/小时比 74±34 毫米/小时，p=0.020），血红蛋白值更低（10.9±1.5 克/分升比 12.1±1.6 克/分升，p<0.001）。在 CDS 前无晕环征的患者中接受皮质类固醇治疗的患者更多（62%比 33%，p=0.005）。17 例（19%）患者发生缺血性卒中，76%发生在后循环，卒中与椎骨晕环征相关（p<0.001）。
晕环征在我们的一半患者中存在。先前的皮质类固醇治疗减少了 CDS 的阳性发现。在晕环征亚组患者中，全身症状和实验室发现更为明显。GCA 患者的卒中病例不成比例地影响后循环。超声检查提供了关于更明显的全身受累和更高的主要并发症风险的信息。
