大动脉炎诊断及活动性评价中国专家调查

Chinese expert investigation on diagnosis and disease activity evaluation in Takayasu's arteritis

目的调查中国医师对大动脉炎(Takayasu′s arteritis,TA)临床诊断与活动性评价的现状。方法全国19位风湿免疫专家、3位血管外科专家参与,通过问卷设计、网络打分,首次就目前TA临床诊断及活动性评估等问题进行回答,采用加权平均法计算相应问题的平均分。结果中国专家目前主要采用1990年美国风湿病学会(American College of Rheumatology,ACR)分类标准进行TA临床诊断。其中,年龄、肢体跛行、黑矇等症状,无脉或脉搏减弱、血管杂音、双侧脉压差增大、高血压等体征,以及急性时相反应蛋白检测,有助于疾病诊断。此外,计算机断层血管造影(computed tomography angiography,CTA)、磁共振血管造影(magnetic resonance angiography,MRA)、血管彩色多普勒超声、正电子发射计算机断层显像(positron emission tomography,PET)等无创影像学检查均被认为具有重要的诊断价值。对于TA活动性评估,中国专家主要采用美国Kerr评分体系。急性时相反应蛋白以及各种无创影像学检查均具有重要的病情活动性评估价值。在影像选择方面,颈动脉受累者更推荐血管超声检查,对于肺动脉、胸/腹主动脉主干受累者则CTA略优于MRA。结论急性时相反应蛋白以及无创影像学检查有助于中国医师对TA的临床诊断及活动性评价。

Objective To investigate the current situation in Chinese rheumatologic physicians＇ clinical diagnosis and evaluation of Takayasu＇ s arteritis （TA）. Methods Nineteen rheumatology experts and three vascular surgery specialists in China were invited to make the nationwide investigation for the first time about the diagnosis and disease activity evaluation of TA in China, through the questionnaire survey on the internet. Weighted average was used to calculate the average scores of corresponding problems. Results Chinese experts mainly adopted 1990 American College of Rheumatology （ACR） classification criteria for clinical diagnosis of TA. In details, symptoms of age, limb claudication and amaurosis, signs including pulselessness or pulse weakening, vascular bruits, increasing bilateral pulse pressure and hypertension and acute phase reactants （APR） were critical to the clinical diagnosis of TA. Besides, noninvasive imaging examinations, such as computed tomography angiography （CTA）, magnetic resonance angiography （MRA）, vascular ultrasonography, and positron emission tomography （PET） were also of great importance. In the aspect of disease activity assessment, Chinese experts mainly used Kerr scoring tool. APR and noninvasive radiological examinations were considered with vital value. Some TA patients with carotid artery involvement were recommended using vascular ultrasonography, while others with pulmonary artery and thoracic/ abdominal aorta trunk involvement were preferred CTA other than MRA. Conclusions APR and noninvasive imaging examinations were thought with great help to make clinical diagnosis and evaluation of TA for Chinese physicians.