巨细胞动脉炎的临床病理类型与预后的相关性分析  

Correlation analysis of the clinicopathologic type and the prognosis in giant cell arteritis

作　　者：王梅英[1] 邹世海[1] 傅碧玲[1] 彭鑫[1] 

机构地区：[1]深圳市宝安区人民医院肾脏风湿内科,518101

出　　处：《国际免疫学杂志》2013年第1期75-78,共4页International Journal of Immunology

摘　　要：目的分析巨细胞动脉炎（GCA）临床病理资料，为该病的诊断、治疗及判断预后提供依据。方法回顾性分析36例GCA患者的病理资料和随访结果。结果确诊的36例GCA患者中，临床表现以头痛最多，其次是颞动脉搏动异常和发热，分别占72．2％、61．1％和47．2％，颞动脉活检阳性率80．6％，其中活动性病变19例（52．8％），慢性病变10例（27．8％），活检阴性7例（19．4％）。所有病例给予激素治疗，部分加用免疫抑制剂。全部病例均获得随访资料。经H检验，3组间差异有统计学意义（H=6．132，P=0．037）；两两比较发现，活动组的好转和治愈百分比（78．9％）高于慢性组（60％），低于活检阴性组（85．7％）。活动组激素治疗效果好，与活检阴性组比较，差异无统计学意（H=9．879，P=0．057）。结论头痛特别是伴有颞动脉搏动异常的头痛是GCA患者的主要症状，激素及免疫抑制剂是目前GCA的首选治疗措施，临床诊断与颞动脉活检病理相结合是诊断GCA的金标准，病理类型是影响预后的重要因素。Objective To study the clinical pathology of Giant cell arteritis and analyze the factors of prognosis. Methods 36 cases of Giant cell arteritis were studied retrospectively. Results The clinical presentations included headache （72.2%）, abnormal pulsation of temporal artery （61.1%） and fever（47.2% ）. The positive rate of temporal artery biopsy was 80.6%, including 19 active cases（ 52.8% ）, 10 chronic cases （27.8%） and 7 biopsy negative cases（ 19.4% ）. All patients were treated with hormone therapy,part of cases were added with immunosuppressive agents. All patients were followed up for information. The improvement and cure percents of three groups were tested by H check, and the difference was evidently significant （ H = 6. 132, P =0.037）. When those were compared between each group by U test,we found the cure percents in active ca- ses group were higher than that in chronic cases, but lower than that in biopsy negative cases group. The effect of hormone treatment was good in active cases group, and there was not a significant difference （H = 9. 879, P =0. 057 ,P 〉 O. 05 ）in comparison with biopsy negative cases group . Conclusion Headache is the major clinical presentations of Giant cell arteritis, especially accompanied by abnormal pulsation of temporal artery. Hormone is the main treatment of Giant cell arteritis and immunosuppressive agents must be adequately used. The combination of clinical diagnosis and temporal artery biopsy may be a gold standard in diagnosis of GCA. The prognosis is related to pathological types of temporal artery.

关 键 词：巨细胞动脉炎 活检 预后 

分 类 号：R543.5[医药卫生—心血管疾病]