大动脉炎颅内血管受累的临床特点分析  

Clinical features of intracranial vessel involvement in Takayasu′s arteritis

作　　者：郭衍秋[1] 杜娟[1] 潘丽丽[1] 郭曦[2] Guo Yanqiu;Du Juan;Pan Lili;Guo Xi(Department of Rheumatology and Immunology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Interventional Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院风湿免疫科,北京100029 [2]首都医科大学附属北京安贞医院介入科,北京100029

出　　处：《中华医学杂志》2020年第23期1789-1794,共6页National Medical Journal of China

摘　　要：目的分析颅内血管受累的大动脉炎(Takayasu′s arteritis,TA)患者的临床特点。方法回顾性分析2012年11月至2018年11月北京安贞医院135例住院TA患者的临床资料,根据有无颅内血管受累,将患者分为颅内血管病变组(32例)和无颅内血管病变组(103例)。比较2组患者的影像学类型、基本临床资料、实验室检查等临床特点。结果TA患者颅内血管受累的比例为23.7%(32/135),最常受累的部位为颈内动脉(颅内段)占59.4%(19/32)。颅内血管病变组既往合并高血压病史及冠心病史发生率分别为46.9%、21.9%,高于无颅内血管病变组的26.2%、6.8%,差异均有统计学意义(χ^2=4.863、4.460,均P<0.05);颅内血管病变组托珠单抗使用率为40.6%,明显高于无颅内血管病变组的19.4%,差异有统计学意义(χ^2=5.945,P<0.05)。颅内血管病变组血小板计数明显低于无颅内血管病变组[(218±55)×10^9/L比(272±71)×10^9/L,t=-3.570,P<0.01],血红蛋白[(130±17)比(121±18)g/L,t=2.363,P<0.05]及三酰甘油[1.22(0.75,1.64)比0.92(0.63,1.21)mmol/L,U=1017.000,P<0.01]明显高于无颅内血管病变组。颅内血管病变组冠状动脉受累比例为43.8%,显著高于无颅内血管病变组的14.6%,差异有统计学意义(χ^2=12.331,P<0.01)。Logistic回归分析发现冠状动脉受累的TA患者并颅内血管受累的比例是无冠脉病变患者的4倍,比值比(OR)=3.965,95%置信区间(CI):1.584~9.926,P=0.003。结论TA颅内血管受累并不少见,合并心血管危险因素的TA患者应重视颅内血管检查。Objective To analyze clinical characteristics of intracranial vessel involvement in Takayasu′s arteritis(TA).Methods Retrospectively analyzed 135 hospitalized TA patients′clinical data in Beijing Anzhen Hospital from November 2012 to November 2018.Based on intracranial artery(IA)complicated or not,TA patients were divided into two groups:32 patients within involvement and 103 patients without involvement.The difference in comparison of imaging types,basic data and laboratory test were analyzed.Results The proportion of TA patients with intracranial vascular involvement was 23.7%(32/135)and the most common site was internal carotid artery(intracranial segment)(59.4%,19/32).The incidences of hypertension and coronary heart disease were significantly higher in TA patients with intracranial vascular involvement compared with the patients without intracranial involvement(46.9%vs 26.2%,21.9%vs 6.8%,χ^2=4.863,4.460,all P<0.05).The rate of tocilizumab treatment in the intracranial vascular involved group was higher than that in the group without intracranial vascular involvement(40.6%vs 19.4%,χ^2=5.945,P<0.05).The platelet count in patients with intracranial involvement group was significantly lower than that in patients without intracranial involvement group[(218±55)×10^9/L vs(272±71)×10^9/L,t=-3.570,P<0.01],while the hemoglobin[(130±17)vs(121±18)g/L,t=2.363,P<0.05]and triglyceride[1.22(0.75,1.64)vs 0.92(0.63,1.21)mmol/L,U=1017.000,P<0.01]were significantly higher than those without intracranial vascular involvement.Moreover,coronary artery involvement presented more frequently in the intracranial vascular involved group than the group without intracranial vascular involvement(43.8%vs 14.6%,χ^2=12.331,P<0.01).Logistic regression analysis showed that the incidence of intracranial vascular disease in TA patients with coronary artery involvement was 4 times higher than that in patients without coronary artery lesions(OR=3.965,95%CI:1.584-9.926,P=0.003).Conclusion The proportion of intracranial vascular involve

关 键 词：Takagasu动脉炎 脑血管障碍 治疗结果 

分 类 号：R593.2[医药卫生—内科学]