多发性大动脉炎9例临床分析

Clinical analysis on 9 cases of Takayasu's arteritis

目的:分析累及肺血管的多发性大动脉炎(Takayasu’s arteritis,TA)的临床特点,以提高临床诊断水平。方法 :回顾分析2005―2012年曾诊断为肺血栓栓塞症,因抗凝治疗效果不佳收治于北京朝阳医院呼吸与危重症医学科的TA患者的临床资料。结果 :TA患者共9例,临床表现主要包括发热(5例)、乏力(3例)、盗汗(2例)、头晕/晕厥(5例)、手足冷/肢体麻木(2例);呼吸系统症状主要为活动后加重的呼吸困难(8例)、咳嗽(5例)、胸痛(5例)和咯血(5例)。CT肺血管检查可见病变多样,范围比较广泛,主要表现为血管狭窄、闭塞和扩张。结论 :累及肺血管的TA临床表现多样,容易误诊。CT肺血管检查可以较好的反应病变特点和范围。激素和免疫抑制剂仍是治疗活动期TA的重要方法。

Objective： To analyze the clinical characteristics and enhance the understanding of Takayasu＇s arteritis（TA） with pulmonary vascular involvement. Methods： The clinical data of 9 TA patients diagnosed with pulmonary thromboembolism previously, who were administrated into Beijing Chaoyang Hospital from 2005 to 2012 due to the poor efficacy of anticoagulant therapy. Results： Totally 9 cases were included. The main clinical manifestations included fever（5 cases）, fatigue（3 cases）, sweating（2 cases）, dizziness/syncope（5 cases）, cold/numbness（2 cases）; respiratory symptoms included dyspnea（8 cases）, cough（5 cases）, chest pain（5 cases） and hemoptysis（5 cases）. CT examination showed pulmonary vascular disease mainly presenting as stenosis, occlusion and expansion. Conclusion： The clinical manifestations of TA with pulmonary vascular involvement are diverse. CT pulmonary vascular screening is a better method to reflect the characteristics and the extent of disease. Treatment should be based on activity of the disease and steroid and immunosuppressants are still the main medicine in the treatment of active TA.