Evans J M, Bowles C A, Bjornsson J, Mullany C J, Hunder G G
Mayo Clinic and Medical School, Rochester, Minnesota.
Arthritis Rheum. 1994 Oct;37(10):1539-47. doi: 10.1002/art.1780371020.
To determine the features and outcomes of patients with giant cell arteritis (GCA) who have aneurysms or rupture of the thoracic aorta.
Patients with GCA seen over a 40-year period who had aneurysms and/or rupture of the thoracic aorta were identified by assistance of a computerized indexing system. The presence of thoracic aortic aneurysms (TAA), with or without aortic valve insufficiency (AI), was determined by radiographs, computed tomography scans, and ultrasound studies of the thorax, angiograms of the aorta, and postmortem examination.
Ten men and 31 women with GCA were found to have TAA and/or rupture. Three developed TAA before GCA was diagnosed, 5 developed aortic findings near the time of the diagnosis, and 33 after the diagnosis of GCA (median of 7 years after diagnosis). Sixteen patients developed acute aortic dissection, which caused death in 8. Nineteen patients also had AI due to aortic root dilation, 15 of whom developed congestive heart failure. Eighteen patients underwent 21 surgical procedures for TAA resection and/or aortic valve replacement or repair. Aortitis was documented histologically in 10 cases.
Thoracic aortic complications in GCA are associated with serious outcomes that have been underrecognized and may be fatal. Physicians should be alert to the development of these complications at any time in the course of GCA, even many years after usual symptoms have subsided.
确定患有胸主动脉瘤或胸主动脉破裂的巨细胞动脉炎（GCA）患者的特征及预后。
借助计算机索引系统，识别出在40年期间就诊的患有胸主动脉瘤和/或破裂的GCA患者。通过胸部X线片、计算机断层扫描、胸部超声检查、主动脉血管造影以及尸检来确定胸主动脉瘤（TAA）的存在，无论有无主动脉瓣关闭不全（AI）。
发现10名男性和31名女性GCA患者患有TAA和/或破裂。3例在GCA诊断前出现TAA，5例在诊断时出现主动脉相关表现，33例在GCA诊断后出现（诊断后中位时间为7年）。16例患者发生急性主动脉夹层，其中8例死亡。19例患者因主动脉根部扩张出现AI，其中15例发展为充血性心力衰竭。18例患者接受了21次手术，进行TAA切除和/或主动脉瓣置换或修复。10例经组织学证实存在主动脉炎。
GCA患者的胸主动脉并发症与严重后果相关，这些后果未得到充分认识且可能致命。医生在GCA病程中的任何时候，即使在常见症状消退多年后，都应警惕这些并发症的发生。
