González-Gay M A, Blanco R, Rodríguez-Valverde V, Martínez-Taboada V M, Delgado-Rodriguez M, Figueroa M, Uriarte E
Hospital Xeral-Calde, Lugo, Spain.
Arthritis Rheum. 1998 Aug;41(8):1497-504. doi: 10.1002/1529-0131(199808)41:8<1497::AID-ART22>3.0.CO;2-Z.
To assess the features and therapeutic response of visual manifestations and cerebrovascular accidents (CVA) in giant cell (temporal) arteritis (GCA) and to identify the predictors for permanent visual loss (VL) and CVA in GCA.
Two hundred thirty-nine patients with biopsy-proven GCA were included in a retrospective multicenter study. Data on demographic, clinical, and laboratory features were collected. The predictors were identified by a forward stepwise nonconditional logistic regression analysis.
Visual involvement was observed in 69 patients, and 34 had permanent VL. The diagnostic delay since the onset of visual symptoms was longer in the 11 patients with bilateral VL. The interval to involvement of the second eye was 5 days. The predictors of permanent VL were transient VL, jaw claudication, normal levels of liver enzymes, and absence of constitutional syndrome. Partial improvement of visual acuity was observed in 8 patients. After adjustment for the treatment regimen (intravenous pulse methylprednisolone versus oral prednisone), early treatment (within the first day of VL) was the only predictor of improvement. CVA, observed in 8 patients, involved the vertebral-basilar territory in 4. CVA was more frequent in patients with visual symptoms, appearing shortly after VL (median 7 days) and despite appropriate therapy. Predictors of CVA were permanent VL and jaw claudication.
In GCA, the risk of permanent VL is increased in patients with transient VL and/or jaw claudication, and decreased in those with elevated liver enzyme levels and/or constitutional syndrome. Partial therapeutic success is more probable if treatment is started within the first day of VL. CVA is more likely in patients with permanent VL and/or jaw claudication, often developing despite appropriate corticosteroid therapy.
评估巨细胞（颞）动脉炎（GCA）的视觉表现和脑血管意外（CVA）的特征及治疗反应，并确定GCA中永久性视力丧失（VL）和CVA的预测因素。
239例经活检证实为GCA的患者纳入一项回顾性多中心研究。收集了人口统计学、临床和实验室特征数据。通过向前逐步非条件逻辑回归分析确定预测因素。
69例患者出现视觉受累，34例发生永久性VL。11例双侧VL患者自视觉症状出现后的诊断延迟较长。第二只眼受累的间隔时间为5天。永久性VL的预测因素为短暂性VL、颌跛行、肝酶水平正常和无全身症状。8例患者视力有部分改善。在调整治疗方案（静脉脉冲甲基强的松龙与口服泼尼松）后，早期治疗（VL发生的第一天内）是改善的唯一预测因素。8例患者发生CVA，4例累及椎基底动脉区域。CVA在有视觉症状的患者中更常见，在VL后不久出现（中位时间7天）且尽管进行了适当治疗。CVA的预测因素为永久性VL和颌跛行。
在GCA中，短暂性VL和/或颌跛行的患者永久性VL风险增加，而肝酶水平升高和/或有全身症状的患者风险降低。如果在VL发生的第一天内开始治疗，部分治疗成功的可能性更大。永久性VL和/或颌跛行的患者发生CVA的可能性更大，尽管进行了适当的皮质类固醇治疗仍常发生。
