大动脉炎患者的临床特点及预后分析

Analysis of clinical characteristics and prognosis in patients with Takayasu＇ s arteritis

目的探讨大动脉炎患者的临床特点及预后。方法回顾性分析首都医科大学附属北京安贞医院2010年1月至2011年12月64例住院大动脉炎患者的临床表现、检查结果、治疗方法及预后情况.结果①64例患者的男女比例为1：3．9，中位发病年龄为40．5岁。②临床分型中广泛型占40．6％（26／64），头臂动脉型占32．8％（21／64），腹主动脉型占25．0％（16／64），肺动脉型占1．6％（1／64）。③最常弛临床症状为高血压、颂胸背血管部位疼痛、头晕、乏力、无脉症、发热、咯血等。④实验室检查结果永35．9％（23／64）患者红细胞沉降率升高，25．0％（16／64）患者C反应蛋白升高。影像学检查结果示病变以血僻狭窄或例塞为主，血流动力学异常。⑤40例患者接受药物治疗，24例患者接受手术治疗。⑥共51例患者接受随访，其中35例患者接受激素药物治疗，30例患者病情好转、2例患者病情无明显改善、3例患者出现病情恶化；16例患者接受手术治疗，人工血管通畅率良好。无死亡病例。结论大动脉炎常表现为高血压和受累部位疼痛。实验室检查和影像学检查结果能帮助确诊分型。患者经激素类治疗后能够很好地缓解病情，对于药物治疗不佳且血管狭窄严重或闭塞的患者，应给予手术治疗，从而改善患者病情。

Objective To investigate clinical features and prognosis in patients with Takayasu＇s arteritis. Methods Totally 64 cases of Takayasu＇s arteritis from January 2010 to December 2011 in Beijing Anzhen Hospital, Capital Medical University were retrospective analyzed, including clinical manifestations, laboratory and imaging examination resuhs, treatments and prognosis. Results ①In 64 cases, the ratio of male to female was 1 ： 3.9, the median age of onset was 40. 5 years old. ②Clinical classifications： extensive arteritis accounted for 40. 6% （26/64）, brachiocephalic arteritis accounted for 32. 8% （21/64）, abdominal aorta arteritis accounted for 25.0% （16/64） , pulmonary artery arteritis accounted for 1.6% （1/64）.③The most common clinical manifestations were hypertension, pain in perivaseular affected areas, dizziness, weakness, pulseless, fever, hemoptysis, etc. ④Laboratory examination showed that 35.9% （23/64） patients had elevated erythrocyte sedimentation rates, 25.0% （16/64） patients had elevated C-reactive protein levels. Imaging examination showed that vascular stenosls or occlusion was major lesion. ⑤In the 64 casess, 40 patients were treated with drugs and 24 patients received surgical treatments. ⑥The follow-up was completed in 51 cases; in 35 cases with hormone therapy, 30 patients got better, 2 patients had no obvious improvement, 3 patients got worse; in 16 eases with surgical treatment, all vascular prosthesis were clear. There was no death case. Conclusions The most common clinical manifestation of Takayasu＇s arteritis is hypertension and pain in affected areas. Laboratory and imaging examinations can help diag- nosis clinical classifications. Hormone therapy is effective in the remission of disease; surgical treatment should be used in patients with poor curative effects in drug treatment and patients with vascular stenosis or occlusion.