大动脉炎合并主动脉瓣反流患者术后免疫抑制治疗效果并文献复习

Post-surgery immune-suppressive treatment for Takayasu＇s arteritis patients with aortic valve regurgitation and literature review

目的探讨大动脉炎合并主动脉瓣反流患者术后免疫抑制治疗的临床效果。方法对3例因大动脉炎合并主动脉瓣反流而行手术治疗的患者进行回顾性分析并进行文献复习。结果3例因大动脉炎合并主动脉瓣反流而行手术治疗的患者，术后不同时间均发现病情活动，其中1例行带瓣人工血管主动脉根部替换术和1例行机械瓣置换术的患者术后及时给予1mg／（kg·d）泼尼松联合甲氨蝶呤治疗，病情平稳；1例行生物瓣膜置换术的患者术后没有进行药物治疗，1年后出现生物瓣衰败。复习文献发现术前和术后的免疫抑制治疗对手术的成功至关重要，术后进行积极免疫抑制治疗的患者长期随访无并发症发生，而2例未使用激素的患者发生了瓣膜脱落，但文献中未提供规范的治疗方案。结论大动脉炎合并主动脉瓣反流的患者手术后常出现病情活动，应密切监测；对有炎症指标升高的患者，可使用大剂量糖皮质激素联合甲氨蝶呤及时控制病情。

Objective To explore the effect of immunosuppressive therapy on takayasu arteritis（TA） patients who suffered from severe aortic valve regurgitation and underwent surgery treatment. Methods Three TA patients who suffered with severe aortic valve regurgitation and underwent surgery treatment were investigated retro- spectively. A comprehensive review of literature was also conducted. Results All of the three patients who under- went surgery for aortic valve regurgitation due to TA suffered from occurrence of TA some time after surgery. The one who underwent Bentall operation and the one who underwent mechanical prosthetic valve replacement received prednisone 1 rag/（ kg - d） combined with methotrexate soon after surgery and thereafter stayed in stable state. Nevertheless, the patient who did not receive immune suppressive therapy after biological valve replacement, biological valve degeneration occurred 1 year after surgery. Review of literature demonstrated that patients who did not recieve sufficient immunosuppresive therapy after sugurey might develop complications such as detachment of the artificial valve. The immunosuppressive therapy of preoperative and postoperative was critical to the success of the operation, however, there was no standard treatment regimen. The post-surgery immunosuppressive therapy has not been underscored. Conclusions Patients who develop aortic valve regurgitation due to TA are prone to have the disease activated after operation; inflammatory biomarkers should be monitored regularly. For those with elevated inflammatory biomarkers, high dose glucocorticoids in combination with methotrexate may be a proper treatment regimen.