Lie J T
Department of Pathology, University of California Davis School of Medicine, USA.
Semin Arthritis Rheum. 1995 Jun;24(6):422-31. doi: 10.1016/s0049-0172(95)80010-7.
Giant cell arteritis (GCA) is closely identified with the temporal arteritis-polymyalgia rheumatica syndrome of the elderly. It is also a systemic disease that can cripple and kill. Up to 15% of patients with temporal arteritis may have angiographic evidence of extracranial GCA, and aortic insufficiency, ruptured aortic aneurysm, aortic dissection, stroke, or myocardial infarction may be the initial manifestation of systemic GCA. A review of 72 cases of aortic and extracranial GCA, all with histopathologic verification of the disease, revealed that 25% of patients with aortic and extracranial large-vessel GCA had asymptomatic temporal arteritis; the ascending aorta and aortic arch were most frequently involved (39%), followed by the subclavian and axillary arteries (26%), and the femoropopliteal arteries (18%). Nine patients (12.5%) underwent an upper or lower limb amputation. Of the 18 patients whose death was directly attributable to extracranial GCA the causes were ruptured aortic aneurysm (6), aortic dissection (6), stroke (3), and myocardial infarction (3). The findings of these 72 cases caution against attributing all aortic and large-vessel arterial disease in the elderly to atherosclerosis and emphasize that timely surgical intervention may be necessary for life-saving and limb-salvage in patients with aortic and extracranial GCA.
巨细胞动脉炎（GCA）与老年人的颞动脉炎 - 风湿性多肌痛综合征密切相关。它也是一种可能导致残疾和死亡的全身性疾病。高达15%的颞动脉炎患者可能有颅外GCA的血管造影证据，主动脉瓣关闭不全、主动脉瘤破裂、主动脉夹层、中风或心肌梗死可能是全身性GCA的初始表现。对72例主动脉和颅外GCA病例进行回顾，所有病例均经组织病理学证实，结果显示25%的主动脉和颅外大血管GCA患者有无症状颞动脉炎；升主动脉和主动脉弓受累最为常见（39%），其次是锁骨下动脉和腋动脉（26%），以及股腘动脉（18%）。9例患者（12.5%）接受了上肢或下肢截肢手术。在18例直接死于颅外GCA的患者中，死因分别为主动脉瘤破裂（6例）、主动脉夹层（6例）、中风（3例）和心肌梗死（3例）。这72例病例的研究结果提醒人们，不要将老年人所有的主动脉和大血管疾病都归因于动脉粥样硬化，并强调对于主动脉和颅外GCA患者，及时进行手术干预对于挽救生命和肢体可能是必要的。
