因疼痛就诊的巨细胞动脉炎病人临床及预后分析

CLINICAL CHARACTERISTICS AND PROGNOSIS OF GIANT CELL ARTERITIS PATIENTS WITH PAIN

目的:探讨因疼痛就诊的巨细胞动脉炎(giant cell arteritis,GCA)病人临床及预后特点。方法:回顾性分析在中国人民解放军总医院住院治疗的41例因头痛或多肌痛就诊的巨细胞动脉炎病人的临床资料,对其临床特点、辅助检查、治疗及转归进行总结。结果:本组病人中,男28例,女13例,发病年龄47~92岁。首发症状中,头痛21例(51.22%)、发热9例(21.95%)、多肌痛3例(7.32%)、乏力2例(4.88%)、视力障碍1例(2.44%)、左上肢麻木1例(2.44%)。起病时即有发热并头痛者3例(7.32%)、肌痛并头痛1例(2.44%)。21例(51.22%)病人体检发现颞浅动脉异常。急性期,血沉>50 mm/h者30例(73.17%),CRP>5 mg/L者24例(58.54%),27例病人行彩色多普勒超声检查,其中23例(85.19%)发现颞浅动脉病变。40例病人使用激素三天后症状均有明显减轻,随访出院后两年的情况,完全缓解无再发者17例,症状反复或出现相关新发症状者23例。经二分类Logistic回归分析,表明急性期血沉与巨细胞动脉炎的预后相关。结论:本组因疼痛就诊的巨细胞动脉炎病人男性多发,多以头痛、发热、多肌痛、乏力为首发症状,26.83%的病人急性期血沉小于50 mm/h,激素治疗均有效。尽早完善颞浅动脉彩超、血沉、C-反应蛋白有利于早期诊断。急性期血沉越高可能提示预后不佳。

Objective:To investigate the clinical features and prognosis of giant cell arteritis(GCA)patients with pain.Methods:A retrospective analysis of the clinical data of 41 patients with GCA who were suffering from headache or polymyalgia in Chinese PLA General Hospital has been performed.The clinical manifestation,assistant examinations,therapy and prognosis were analyzed and summarized.Results:There were 28 male cases and 13 female cases.The age of onset was ranged from 49 to 92 years.Headache and fever were most prominent symptoms at onset,which occurred in 21 cases(51.22%)and 9 cases(21.95%)respectively,followed by polymyalgia(3,7.32%),asthenia(2,4.88%),visual disturbance(1,2.44%),numbness in left upper limb(1,2.44%).Additionally,there were 3(7.32%)patients with fever and headache,1(2.44%)patient with polymyalgia and headache,and 21 patients(51.22%)with temporal artery abnormal morphology and pulsation.In acute phase,there were 30(73.17%)patients whose erythrocyte sedimentation rate was higher than 50 mm/hour,24(58.54%)patients whose C reactive protein was higher than 5 mg/L.Temporal artery ultrasound results showed abnormity in 23 cases(85.19%).Three days after steroid hormone treatment,40 patients were significantly released.At 2 years follow-up,17 patients were completely released without recurrence,23 patients were recurred or had new onset compatible with GCA.Based on binary logistic regression,it was manifested that erythrocyte sedimentation rate in acute stage was a predictive factor of the prognosis of GCA.Conclution:The male incidence was higher than female in these patients with GCA who were suffering from pain.Headache,fever,polymyalgia and asthenia were more common at onset.Erythrocyte sedimentation rate in acute phase was lower than 50 mm/hour in 26.83%patients.Steroid was effective for relieving of symptoms.It was beneficial to early diagnosis by taking Color duplex ultrasonography of temporal artery and testing C reactive protein as soon as possible.The level of erythrocyte sedimentation rate in acute phase might affect the prognosis of giant cell arteritis.