摘要
目的 探讨中国人巨细胞动脉炎 (GCA)的临床特征及治疗。方法 对诊断为GCA的16例患者 ,根据临床症状、颞动脉活检、类固醇激素治疗效果及随访结果作为诊断标准 ,以 1990年美国风湿病学会 (ACR)制定的GCA诊断标准作参考。结果 16例患者被诊为GCA ,其中 13例符合ACR的GCA诊断标准。发病年龄平均 4 3 1岁 ;男∶女为 15∶1;最常见的临床症状为头痛、颞动脉异常、视力障碍、发烧 ;非常见临床表现有下颌关节间歇性乏力、易疲劳、晕厥、轻偏瘫等 ;红细胞沉降率升高11例 ,颞动脉活检发现炎性细胞浸润 11例 ,内弹力膜断裂 16例 ,纤维素性坏死 3例 ,平滑肌细胞病变10例 ,腔内血栓形成 5例。从发病到怀疑GCA或颞动脉活检的平均时间 5 5个月 ;初诊的误诊率达87 5 %。结论 中国人中GCA可能不是一种少见病 ,发病年龄相对较轻 ,男性为多 ,其临床特征尚未得到广泛认识 ,延误了恰当的诊断与治疗。
Objective To investigate the clinical features of giant cell (temporal ) arteritis (GCA) in China Methods The clinical manifestations, temporal artery biopsy, response to steroid therapy, and follow up data of sixteen patients with the diagnosis of GCA from July 1999 to March 2001 were analyzed The American College of Rheumatology (ACR) criteria for classification of GCA were used as reference Results Twenty one patients who sought medical advice in the Second Hospital Affiliated to Xiangya Medical College were suspected of GCA A definite diagnosis of GCA was made among sixteen patients The diagnosis among 13 of them fulfilled the 1990 American College of Rheumatology criteria for the classification of GCA The mean age at disease onset was 43 13 years(range 28～60 years)and 81 25 % of the patients were under the age of 50 when they came down with the disease The ratio between male and female cases was 15:1 The commonest initial clinical manifestations included newly occuring headache, temporal artery abnormality, visual symptoms, fever, and raised erythrocyte sedimentation rate Jaw claudication, fatigue, syncope, and hemiparesis could be found in some patients All the 16 patients underwent temporal artery biopsy Light and electron microscopy showed inflammatory cell infiltration in arterial wall in 11 cases, fragmented internal elastica in 16 cases, fibrinoid necrosis in 3 cases, smooth muscle cell changes in 10 cases, and thrombosis in the lumen in 5 cases The mean time from symptom onset to suspicion of GCA or biopsy was 5 52 months (range 0 25～24 33 months) The misdiagnosis rate during first visit was 87 50% Conclusion GCA may not be a rare disorder in China In comparison with the cases abroad, the Chinese GCA patients come down with disease at the earlier age, and most Chinese GCA patients are male This disease is not understood by many clinicians in China Misdiagnosis is common
出处
《中华医学杂志》
CAS
CSCD
北大核心
2002年第7期453-455,共3页
National Medical Journal of China
