80例大动脉炎临床资料回顾性分析

Retrospective study of 80 patients with Takayasu'arteritis

目的探讨大动脉炎的误诊和预后。方法回顾性分析80例大动脉炎患者的临床症状、误诊、治疗和预后。结果①80例患者中,头臂动脉型患者31例,约占38.8%;胸腹主动脉型4例,占5.0%;广泛型(头臂动脉型+胸腹主动脉型)43例,占53.8%;肺动脉型2例,占2.5%。②常见临床首发症包括双上肢血压不等(包括单侧或双侧血压测不出)、血管杂音、头晕头痛、无脉或脉搏减弱、乏力。③80例患者在发病初期,有37例患者被误诊,误诊率高达46.3%。④80例患者中49例接受糖皮质激素或糖皮质激素联合其他免疫抑制剂治疗,病情达到缓解。⑤对21例患者回访发现,14例患者接受小剂量糖皮质激素(包括糖皮质激素联合免疫抑制剂)或单用抗凝药等病情控制良好;6例患者不正规治疗病情控制不佳;1例患者因大动脉炎所致心力衰竭死亡。结论大动脉炎误诊率较高,医生的全面体检能有效降低误诊率。糖皮质激素或糖皮质激素联合免疫抑制剂能有效控制病情,患者定期随访及正规治疗能有效改善病情,延缓病情进展。

Objective To investigate the misdiagnosis and prognosis of Takayasuhrteritis. Methods The clinical symptoms, misdi- agnosis,treatment and prognosis of 80 TA patients were retrospectively studied. Results ①Among 80 patients, the type of braehiocephalic arteries was in 31 cases （38.8%） ;thoracoabdominal aortic type was in 4 cases （5.0%） ;widespread （brachiocephalic artery ＋ thoracoab- dominal aortic ） type was in 43 cases （53.8%） ;pulmonary type was in 2 cases （2.5%）. ②The common first clinical symptoms included double upper limb blood pressure ranges （ including unilateral or bilateral undetectable blood pressure） , vascular murmur, dizziness, head- ache,no pulse or pulse weakened, and weakness. ③In the early stages, there are 37 patients of the 80 patients were misdiagnosed, with the misdiagnosis rate of 46.3 %. ④Among 80 patients ,49 patients received glucocorticoid or glueocorticoid combined with other immunosuppres- sive agents for therapy,and the condition of disease achieved remission. ⑤ Totally 21 patients were followed up, 14 patients received low - dose glneocorticoids（ including glucoeorticoid combined with immunosuppressive agents） or other anticoagulants alone,and the remission was achieved ;6 patients with poorly controlled disease were without formal treatment;1 patient died due to Takayasu arteritis. Conclusion Taka- yasu arteritis has a higher rate of misdiagnosis. Comprehensive medical examination can effectively reduce the rate of misdiagnosis. Glucocorti- colds or glucocorticoids combined with imnmnosuppressive agents can effectively control the disease. Regular follow - up and regular treatment of patients can effectively improve the condition and delay the disease progression.