仅在无风湿性多肌痛的巨细胞动脉炎患者中，大血管血管炎是复发的一个危险因素。
Large vessel vasculitis is a risk factor for relapse only in giant cell arteritis patients without polymyalgia rheumatica.
作者信息
Moreel Lien, Betrains Albrecht, Boeckxstaens Lennert, Molenberghs Geert, Van Laere Koen, De Langhe Ellen, Vanderschueren Steven, Blockmans Daniel
机构信息
Department of General Internal Medicine, UZ Leuven, Leuven, Belgium.
Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
出版信息
Rheumatology (Oxford). 2025 Apr 1;64(4):2068-2076. doi: 10.1093/rheumatology/keae456.
OBJECTIVES
To evaluate differences in presentation and outcome of GCA patients with and without large vessel vasculitis (LVV) and according to the extent and severity of LVV.
METHODS
Consecutive patients diagnosed with GCA between 2003 and 2020 who have had FDG PET imaging at diagnosis ≤3 days after initiation of glucocorticoids (GC) and followed for ≥12 months at the University Hospitals Leuven (Belgium) were included retrospectively. PET scans were visually scored (0-3) in seven vascular areas and a total vascular score (TVS) was calculated. LVV was defined as FDG uptake ≥2 in any large vessel.
RESULTS
We included 238 GCA patients, of which 169 (71%) had LVV. LVV patients were younger (69 vs 74 years, P < 0.001) and more frequently female (72% vs 49%, P = 0.001). In patients without PMR symptoms, the presence of LVV was associated with relapse (aOR 3.05 [95% CI 1.32-7.43], P = 0.011) and with a lower probability of stopping GC (aHR 0.59 [95% CI 0.37-0.94], P = 0.025). However, in those with PMR symptoms, there was no difference in relapse risk (aOR 1.20 [95% CI 0.53-2.66], P = 0.657) and in the probability of stopping GC (aHR 1.25 [95% CI 0.75-2.09], P = 0.394) between patients with and without LVV. A higher TVS was associated with an increased risk of relapse (aOR 1.09 [95% CI 1.04-1.15], P = 0.001) in patients without PMR symptoms, but not in those with PMR symptoms (aOR 1.01 [95% CI 0.96-1.07], P = 0.693).
CONCLUSION
LVV is a risk factor for relapse in GCA patients without PMR symptoms with a higher relapse risk in those with higher TVS.
目的
评估合并和不合并大血管血管炎（LVV）的巨细胞动脉炎（GCA）患者在临床表现和预后方面的差异，并根据LVV的范围和严重程度进行评估。
方法
回顾性纳入2003年至2020年间在比利时鲁汶大学医院确诊为GCA且在开始使用糖皮质激素（GC）后≤3天内进行了氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）成像且随访≥12个月的连续患者。对PET扫描的七个血管区域进行视觉评分（0 - 3分），并计算总血管评分（TVS）。LVV定义为任何大血管中FDG摄取≥2。
结果
我们纳入了238例GCA患者，其中169例（71%）合并LVV。合并LVV的患者更年轻（69岁对74岁，P < 0.001），女性比例更高（72%对49%，P = 0.001）。在没有风湿性多肌痛（PMR）症状的患者中，LVV的存在与复发相关（调整后比值比[aOR] 3.05 [95%置信区间（CI）1.32 - 7.43]，P = 0.011），且停用GC的概率较低（调整后风险比[aHR] 0.59 [95% CI 0.37 - 0.94]，P = 0.025）。然而，在有PMR症状的患者中，合并和不合并LVV的患者在复发风险（aOR 1.20 [95% CI 0.53 - 2.66]，P = 0.657）和停用GC的概率（aHR 1.25 [95% CI 0.75 - 2.09]，P = 0.394）方面没有差异。在没有PMR症状的患者中，较高的TVS与复发风险增加相关（aOR 1.09 [95% CI 1.04 - 1.15]，P = 0.001），但在有PMR症状的患者中并非如此（aOR 1.01 [95% CI 0.96 - 1.07]，P = 0.693）。
结论
LVV是没有PMR症状的GCA患者复发的危险因素，TVS较高的患者复发风险更高。
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