巨细胞动脉炎的临床分析(附8例报告)

The diagnosis and treatment of giant cell arteritis: eight cases analysis

目的分析巨细胞动脉炎的临床表现、辅助检查结果及对不同治疗的效果和误诊的原因。方法对8例患者的首发症状、临床表现、局部检查、实验室检查、组织学检查和对不同治疗的效果进行分析。结果巨细胞动脉炎可以有不同的首发表现形式,但头痛是主要的临床症状(6例)。实验室检查:8例血沉均增快,平均86mm/h;5例血红蛋白减低,平均为6.1g/L;4例CRP增高,平均为132mg/L。颞动脉组织学检查是诊断的一种重要手段,3例行颞动脉检查(6条),5条内膜欠光滑、腔内回声不佳;1条未见异常。皮质激素有非常明显的治疗效果。结论对以头痛为首发症状的中老年人,特别是颞、枕和颈部胀痛和剧痛,伴或不伴发热、眼胀和复视的患者,要行颞动脉触诊检查,注意血红蛋白、ESR和CRP的变化,必要时行颞动脉超声检查,颞动脉分段活检是诊断巨细胞颞动脉炎的金标准,皮质激素是治疗的首选。

Objective To observe the clinical manifestations, examinations, different responses to treatment in the giant cell arteritis patients and analyze the causes of misdiagnosis. Methods Eight patients on the initial symptom, clinical pictures, local manefestations, blood tests, blood vessel biopsy and treatment response were analyzed. Results Giant cell arteritis could have different manifestations, but headache was the main clinical symptoms. ESR and CRP have increased significantly. The temporal artery histological examination was an important way of diagnosis, but attention should be paid to the effect of false negative. The corticosteroid had a very good effect. Conclusions When the initial symptom is headache, especial in the temporal, occipital area and neck pain in elderly, with or without fever, eye diplopia, patient should be examined by palpation of the temporal arteries and special attention should be paid to Hg, ESR and CRP. If necessary, arteritis temporal artery ultrasonography should be examined. Temporal artery biopsy is the gold standard for the diagnosis of giant cell. Corticosteroids administration is the first choice of treatment.