Robles M, Reyes P A
Instituto Nacional de Cardiología I. Chávez, Department of Immunology, Mexico D.F., Mexico.
Clin Exp Rheumatol. 1994 Jul-Aug;12(4):381-8.
To review our experience in clinical diagnosis of the non-specific arteritis called Takayasu's arteritis (TA), and to assess its possible relationship with previous mycobacterial infections as judged by delayed hypersensitivity skin test.
We examined 44 consecutive patients in Mexico City. All of them fulfilled the ACR criteria for the classification of TA and had a characteristic panaortogram in the absence of any other arterial or systemic disease.
Forty-three of our patients were Mexican mestizos; only one had a Caucasian appearance. 38 were women, and the age at diagnosis ranged from 15 to 64 years with a mean of 32 and a median of 35. Age at onset of the symptoms was under 30 years in most cases. Five patients had type I disease, and 4 had type II. Most had a diffuse arteritis (type III), and in seven cases involvement of the pulmonary artery (type IV) was recognized. All patients showed abnormal peripheral pulses and blood pressure differences, 35 had systemic arterial hypertension and 7 pulmonary hypertension. A noisy vascular auscultation was very common and cardiac ailments were also found in many cases. Systemic complaints such as fever, weight loss and malaise were present in the active stages of the disease. Arthritis did occur in a single case, arthralgia was frequent and inflammatory nodules involving the shin, perimalleolar area, and the antero-external surface of the distal leg were also common. Polyclonal hypergammaglobulinemia was a frequent finding in active and inactive cases; leukocytosis with neutrophilia, accelerated ESR and high fibrinogen, however, did occur when the disease was active. Eight of our patients had a previous diagnosis of tuberculosis, and 81% developed a delayed skin reactivity to PPD (2U old tuberculin). None had a bacteriologic diagnosis of tuberculosis or mycobacterial disease.
Non-specific arteritis, or Takayasu's disease, frequently affects young women of colored race in Mexico. Late diagnosis is common and cardiovascular features dominate the clinical picture. Arterial compromise is widespread and may involve the pulmonary artery and its branches. Most cases are inactive and morbidity results from systemic arterial hypertension and heart disease; active cases have systemic complaints and laboratory abnormalities suggestive of ongoing inflammation. The close relationship between Takayasu's arteritis and previous contact with Mycobacterium tuberculosis was again confirmed in our series, although further studies are necessary to clarify this probable relationship.
回顾我们在诊断名为高安动脉炎（TA）的非特异性动脉炎方面的经验，并通过迟发型超敏皮肤试验评估其与既往分枝杆菌感染的可能关系。
我们对墨西哥城的44例连续患者进行了检查。所有患者均符合美国风湿病学会（ACR）制定的TA分类标准，并且在无任何其他动脉或全身性疾病的情况下具有典型的全主动脉造影表现。
我们的43例患者为墨西哥混血儿；只有1例具有白种人外貌。38例为女性，诊断时年龄在15至64岁之间，平均年龄为32岁，中位数为35岁。大多数患者症状出现时年龄在30岁以下。5例为I型疾病，4例为II型。大多数患者为弥漫性动脉炎（III型），7例患者发现有肺动脉受累（IV型）。所有患者均表现为外周脉搏异常和血压差异，35例有系统性动脉高血压，7例有肺动脉高压。血管听诊有杂音非常常见，许多病例还发现有心脏疾病。在疾病的活动期存在发热、体重减轻和不适等全身症状。仅1例发生关节炎，关节痛很常见，累及胫骨、踝关节周围区域以及小腿远端前外侧表面的炎性结节也很常见。在活动期和非活动期病例中均常见多克隆高球蛋白血症；然而，当疾病活动时会出现白细胞增多伴中性粒细胞增多、血沉加快和纤维蛋白原升高。我们的8例患者既往曾被诊断为结核病，81%的患者对结核菌素纯蛋白衍生物（PPD，2U旧结核菌素）出现迟发型皮肤反应。无一例有结核病或分枝杆菌病的细菌学诊断。
非特异性动脉炎或高安病在墨西哥经常影响有色人种的年轻女性。延迟诊断很常见，心血管特征在临床表现中占主导地位。动脉受累广泛，可能累及肺动脉及其分支。大多数病例为非活动期，发病是由系统性动脉高血压和心脏病引起的；活动期病例有全身症状和提示持续炎症的实验室异常。尽管需要进一步研究以阐明这种可能的关系，但在我们的系列研究中再次证实了高安动脉炎与既往接触结核分枝杆菌之间的密切关系。
