von Blotzeim S G, Borruat F X
Hôpital Ophtalmique Jules Gonin, Lausanne.
Klin Monbl Augenheilkd. 1996 May;208(5):397-9.
Giant cell arteritis (GCA) is a systemic segmental vasculitis of unknown etiology, typically affecting elderly patients. Elevated erythrocyte-sedimentation rate (ESR) is usually found in such patients.
One hundred and twenty three patients underwent temporal artery biopsy in our institution between 1977 and 1995. Among them, 66 (53.7%) biopsies were positive (i.e. histologic findings were very suggestive of GCA). The clinical charts from all patients with positive biopsies were retrieved and 47 were eligible for our study (inadequate data in 19 cases).
Seven of the 47 patients with positive biopsies (15%) had a normal ESR and 70% (33/47 cases) had neuro-ophthalmic complications including anterior ischemic optic neuropathy, central retinal artery occlusion, choroidal ischemia and extraocular muscle and/or cranial nerve palsy (III, IV, VI). No differences were found between the groups with normal or elevated ESR as 87.5% (6/7 cases) of the group with normal ESR exhibited neuro-ophthalmic complications.
ESR was normal in 15% of our GCA patients and these patients had the same frequency of neuro-ophthalmic complications as the GCA patients with elevated ESR. Thus, our study does not support the previous concept that patients with higher ESR are more at risk for neuro-ophthalmic complications. GCA with normal ESR is not rare and such patients should be investigated with other blood studies (C-reactive protein) and with fluorescein angiography.
巨细胞动脉炎（GCA）是一种病因不明的系统性节段性血管炎，通常影响老年患者。此类患者通常血沉（ESR）升高。
1977年至1995年间，我院123例患者接受了颞动脉活检。其中66例（53.7%）活检呈阳性（即组织学结果高度提示GCA）。检索了所有活检阳性患者的临床病历，47例符合我们的研究条件（19例数据不充分）。
47例活检阳性患者中有7例（15%）ESR正常，70%（33/47例）有神经眼科并发症，包括前部缺血性视神经病变、视网膜中央动脉阻塞、脉络膜缺血以及眼外肌和/或脑神经麻痹（Ⅲ、Ⅳ、Ⅵ）。ESR正常或升高的组间未发现差异，因为ESR正常组中87.5%（6/7例）有神经眼科并发症。
我们的GCA患者中有15%的ESR正常，这些患者神经眼科并发症的发生率与ESR升高的GCA患者相同。因此，我们的研究不支持先前的观念，即ESR较高的患者发生神经眼科并发症的风险更高。ESR正常的GCA并不罕见，此类患者应进行其他血液检查（C反应蛋白）和荧光素血管造影检查。
