Pountain G D, Calvin J, Hazleman B L
Rheumatology Research Unit, Addenbrooke's Hospital, Cambridge.
Br J Rheumatol. 1994 Jun;33(6):550-4. doi: 10.1093/rheumatology/33.6.550.
Forty-four patients with polymyalgia rheumatica and/or giant cell arteritis (PMR/GCA) were followed from presentation, through remissions and relapses for a median duration of 36 months. Clinical disease activity, ESR, CRP and alpha 1-antichymotrypsin (alpha 1-ACT) were measured. Before treatment ESR, CRP and alpha 1-ACT were all significantly raised, compared with age- and sex-matched controls. On clinical remission with prednisolone treatment, ESR and CRP fell to control levels but alpha 1-ACT behaved quite differently, remaining raised for 18 months or until prednisolone treatment could be withdrawn. At 18 month follow-up of PMR/GCA, and alpha 1-ACT level of < or = 0.7 g/l was associated with a reduced risk of subsequent relapse (P = 0.006). At clinical relapse during treatment, ESR was not raised compared with controls, and CRP, although significantly higher than controls (P = 0.015), remained less than 6 mg/l in the majority of patients. The three laboratory investigations were, therefore, of limited value in confirming relapses of PMR/GCA during prednisolone treatment, but alpha 1-ACT may be useful as an indicator of underlying disease activity and hence as a guide to the speed that the prednisolone dosage should be reduced.
44例风湿性多肌痛和/或巨细胞动脉炎（PMR/GCA）患者自就诊起接受随访，历经缓解期和复发期，中位随访时间为36个月。测定了临床疾病活动度、血沉（ESR）、C反应蛋白（CRP）和α1-抗糜蛋白酶（α1-ACT）。与年龄和性别匹配的对照组相比，治疗前ESR、CRP和α1-ACT均显著升高。使用泼尼松龙治疗临床缓解后，ESR和CRP降至对照水平，但α1-ACT表现迥异，持续升高18个月或直至泼尼松龙治疗可停用。在对PMR/GCA患者进行18个月随访时，α1-ACT水平≤0.7 g/L与后续复发风险降低相关（P = 0.006）。在治疗期间临床复发时，与对照组相比ESR未升高，CRP虽显著高于对照组（P = 0.015），但大多数患者仍低于6 mg/L。因此，这三项实验室检查在确认泼尼松龙治疗期间PMR/GCA复发方面价值有限，但α1-ACT可能有助于作为潜在疾病活动度的指标，从而指导泼尼松龙剂量应降低的速度。
