基于队列研究的大动脉炎临床特点分析

Clinicial features of Takayasu arteritis:a cohort study

目的分析华东大动脉炎队列(ECTA)患者及其亚组的临床特征,观察其疾病特点。方法基于ECTA队列,收集队列中2009年1月至10月初诊大动脉炎患者资料,根据性别、年龄、疾病活动、治疗等分组,采用t检验或Wilcoxon秩和检验或χ2检验对不同亚组进行比较,分析大动脉炎的临床特点。结果454例大动脉炎患者中,男女比1∶4.75(79/375);症状以头晕/头痛、乏力和胸闷/胸痛为主;影像学分型Ⅴ型和Ⅰ型最常见,锁骨下动脉和颈动脉最常受累,主要表现为血管狭窄。并发症以高血压为主,结核与乙型肝炎是较常见的合并感染。亚组分析显示,活动组、女性患者、低龄(年龄<40岁)和初治组的患者症状分别较非活动组、男性、高龄(年龄≥40岁)和经治组明显,活动组炎症指标如CRP[10(2,33)mg/L与3(1,14)mg/L,Z=-4.49,P<0.01]、ESR[(45±33)mm/1 h与(25±23)mm/1 h,t=-5.82,P<0.01]等均显著高于非活动组,而女性患者仅ESR高于男性,但差异无统计学意义;低龄组SAA、初治组ESR明显高于另一亚组[19(6,95)mg/L与10(4,39)mg/L,Z=2.06,P<0.05][(44±34)mm/1 h与(32±28)mm/1 h,t=3.77,P<0.01]。结论大动脉炎患者以年轻女性为主,Ⅴ型和Ⅰ型最常见,初诊时疾病多处于活动状态。大动脉炎患者常合并高血压,可伴有结核等感染。

Objective To analyze the characteristics of patients with Takayasu arteritis(TA)in the east China Takayasu arteritis(ECTA)cohort and their subgroups,and evaluate the disease characteristics.Methods Patients diagnosed with TA in ECTA cohort from January 2009 to October 2019 were enrolled and their data were analyzed.The characteristics were analyzed and compared within subgroups using t-test or Wilcoxon rank sum test or Chi-square test.Results A total of 454 patients were included,with the male to female ratio of 1∶4.75(79/375),and the main complaint were dizziness/headache,fatigue,and chest tightness/pain.The typeⅤandⅠwere the most common angiographic pattern,among which the subclavian artery and carotid artery were most vulnerable,manifested as vascular stenosis.Hypertension,tuberculosis and hepatitis B were common complications.In subgroup comparison,symptoms and inflammation index were much more evident in the active group,female group,<40 years old,and newly diagnosed group.C-reactive protein(CRP)[10(2,33)mg/L vs 3(1,14)mg/L,Z=-4.49,P<0.01),erythrocyte sedimentation rate(ESR)[(45±33)mm/1 h vs(25±23)mm/1 h,t=-5.82,P<0.01),in the active group were significantly higher than those in the inactive group,while the ESR in female patients was only higher than that in males,but without statistical significant difference.SAA in the young age group,ESR in the newly diagnosed group was significantly higher than that in the other subgroups[19(6,95)mg/L vs 10(4,39)mg/L,Z=2.06,P<0.05][(44±34)mm/1 h vs(32±28)mm/1 h,t=3.77,P<0.01].Conclusion The TA patients are mainly young women,and are in active disease when first being diagnosed.The typeⅤandⅠare the most common artery involve-ment pattern.Hypertension and tuberculosis are the most frequent complications.