Chen Rongyi, Sun Ying, Liu Ying, Ding Jing, Jiang Lindi
Department of Rheumatology, Zhongshan Hospital Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
Center of Evidence-based Medicine, Fudan University, Shanghai, 200032, China.
BMC Rheumatol. 2025 Aug 13;9(1):100. doi: 10.1186/s41927-025-00551-6.
Patients suffering from Takayasu arteritis (TA) with stenosis or occlusion of supra-aortic trunks carry a high risk of cerebral vascular ischemic events (CVIEs). We explored the relationship between cerebral blood perfusion and CVIEs in TA.
Patients with involvement of supra-aortic trunks undergoing computed tomographic perfusion (CTP) were enrolled. The primary endpoint was CVIEs. The secondary endpoint was a poor outcome (modified Rankin scale, mRS > 3). The relationship between CTP parameters, ischemic deficit (time to maximum, T >6 s) and ischemic core (cerebral blood flow, CBF < 30%), CVIEs, and a poor outcome during follow-up was analyzed with Spearman correlation, Cox regression, cluster analysis, and Kaplan–Meier curves.
Eighty-one patients were enrolled. The median volume of the ischemic deficit was 2.5 (IQR 0–34.1) mL. The ischemic deficit was related to a previous ischemic stroke, abnormal vision, and vertebral-artery stenosis (all < 0.05). During a median follow-up of 16.0 (IQR 3.0–29.0) months, 16 cases suffered CVIEs, including ischemic stroke (11 cases, 68.8%), ablepsia (six, 37.5%), death (three, 18.8%), other worsening cerebral ischemic symptoms (three, 18.8%). The CVIEs were independently associated with the ischemic deficit (hazard ratio, HR = 15.66[4.09–59.96], < 0.001), hemoglobin (HR = 0.96[0.93–0.99], = 0.003), and tocilizumab use (HR = 5.71[1.63–20.00], < 0.001). The AUC of the ischemic deficit to predict CVIEs was 0.79 (95%CI = 62.07–95.62) at 1 year and 0.81 (95%CI = 0.65–0.96) at 3 years, respectively. Furthermore, patients could be clustered into three groups. Cluster 1 (inflammation type) and cluster 2 (non-inflammation type) shared a similar risk for CVIEs. Cluster 3 (inflammation with low-perfusion type) carried the highest risk for a CVIE (HR 35.21[4.63–267.58], < 0.001) compared with cluster 1. Kaplan–Meier curves revealed that patients with high ischemic deficit or belonging to cluster 3 carried a higher risk of CVIEs or a poor outcome.
The high ischemic deficit is a risk factor for CVIEs in TA with involvement of supra-aortic trunks. Patients with inflammation and high ischemic deficit carry a high risk of suffering CVIEs and a poor outcome during follow-up.
RETROSPECTIVELY REGISTERED. TRIAL REGISTRATION: ClinicalTrials.gov NCT03893136
2019-03-25.
The online version contains supplementary material available at 10.1186/s41927-025-00551-6.
患有Takayasu动脉炎（TA）且主动脉弓上分支存在狭窄或闭塞的患者发生脑血管缺血事件（CVIEs）的风险很高。我们探讨了TA患者脑血流灌注与CVIEs之间的关系。
纳入接受计算机断层扫描灌注（CTP）检查且主动脉弓上分支受累的患者。主要终点是CVIEs。次要终点是不良结局（改良Rankin量表，mRS＞3）。采用Spearman相关性分析、Cox回归分析、聚类分析和Kaplan–Meier曲线分析CTP参数、缺血性缺损（达峰时间，T＞6秒）和缺血核心（脑血流量，CBF＜30%）与随访期间CVIEs及不良结局之间的关系。
共纳入81例患者。缺血性缺损的中位数体积为2.5（IQR 0–34.1）mL。缺血性缺损与既往缺血性卒中、视力异常和椎动脉狭窄相关（均P＜0.05）。在中位随访期16.0（IQR 3.0–29.0）个月期间，16例发生CVIEs，包括缺血性卒中（11例，68.8%）、失明（6例，37.5%）、死亡（3例，18.8%）、其他脑缺血症状恶化（3例，18.8%）。CVIEs与缺血性缺损（风险比，HR = 15.66[4.09–59.96]，P＜0.001）、血红蛋白（HR = 0.96[0.93–0.99]，P = 0.003）和使用托珠单抗（HR = 5.71[1.63–20.00]，P＜0.001）独立相关。缺血性缺损预测CVIEs的1年AUC为0.79（95%CI = 62.07–95.62），3年AUC为0.81（95%CI = 0.65–0.96）。此外，患者可分为三组。第1组（炎症型）和第2组（非炎症型）发生CVIEs的风险相似。与第1组相比，第3组（炎症伴低灌注型）发生CVIEs的风险最高（HR 35.2[4.63–267.58]，P＜0.001）。Kaplan–Meier曲线显示，缺血性缺损高或属于第3组的患者发生CVIEs或不良结局的风险更高。
高缺血性缺损是主动脉弓上分支受累的TA患者发生CVIEs的危险因素。炎症且缺血性缺损高的患者在随访期间发生CVIEs和不良结局的风险很高。
回顾性注册。试验注册：ClinicalTrials.gov NCT03893136
2019年3月25日。
在线版本包含可在10.1186/s41927-025-00551-6获取的补充材料。
