Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Arthritis Res Ther. 2022 May 7;24(1):102. doi: 10.1186/s13075-022-02788-9.
Aortic valve involvement is not uncommon in patients with Takayasu arteritis (TAK) and leading to poor prognosis. The aim of our study was to explore the risk factors of aortic valve involvement and to evaluate the prognosis in TAK patients with aortic valve involvement.
In this retrospective study, 172 TAK patients were divided into groups with or without aortic valve involvement to identify the risk factors. Patients who underwent aortic valve surgical treatment were followed up to assess cumulative incidence of postoperative adverse events.
A total of 92 TAK patients (53.49%) had aortic valvular lesion. The infiltration of inflammatory cells was found in surgical specimens of aortic valve. Numano type IIb, elevated high-sensitivity C-reactive protein (hs-CRP) level, and dilation of ascending aorta and aortic root were statistically associated with aortic valvular lesion in TAK patients (OR [95%CI] 6.853 [1.685-27.875], p=0.007; 4.896 [1.646-14.561], p=0.004; 4.509 [1.517-13.403], p=0.007; 9.340 [2.188-39.875], p=0.003). The 1-, 5-, and 7-year cumulative incidence of postoperative adverse events were 14.7%, 14.7%, and 31.8%, respectively. Surgical methods (p=0.024, hazard ratio (HR) 0.082) and postoperatively anti-inflammatory therapy (p=0.036, HR 0.144) were identified as potential predictors of postoperative adverse events.
Regularly echocardiogram screening is suggested in patients with Numano type IIb and aggressive treatment should be performed early in TAK patients. As for TAK patients with aortic valve surgery, aortic root replacement seems to be the preferred option and regular anti-inflammatory therapy may reduce the occurrence of adverse events of them.
升主动脉炎（TAK）患者常合并主动脉瓣受累，导致预后不良。本研究旨在探讨主动脉瓣受累的危险因素，并评估主动脉瓣受累 TAK 患者的预后。
本回顾性研究共纳入 172 例 TAK 患者，根据是否合并主动脉瓣受累分为两组，以确定危险因素。对接受主动脉瓣手术治疗的患者进行随访，评估术后不良事件的累积发生率。
共 92 例（53.49%）TAK 患者存在主动脉瓣病变。主动脉瓣手术标本中可见炎性细胞浸润。Numano Ⅱb 型、高敏 C 反应蛋白（hs-CRP）升高、升主动脉和主动脉根部扩张与 TAK 患者主动脉瓣病变相关（比值比[95%置信区间]：6.853[1.68527.875]，p=0.007；4.896[1.64614.561]，p=0.004；4.509[1.51713.403]，p=0.007；9.340[2.18839.875]，p=0.003）。术后 1、5、7 年不良事件累积发生率分别为 14.7%、14.7%和 31.8%。手术方式（p=0.024，风险比（HR）0.082）和术后抗炎治疗（p=0.036，HR 0.144）是术后不良事件的潜在预测因素。
建议对 Numano Ⅱb 型 TAK 患者定期行超声心动图筛查，早期对 TAK 患者进行积极治疗。对于主动脉瓣手术的 TAK 患者，主动脉根部置换似乎是首选，定期抗炎治疗可能降低其不良事件的发生。
