论文摘要
研究目的:分析巨细胞动脉炎（Giant cell arteritis,GCA）患者临床特点。研究方法:回顾性分析北京协和医院自1983年1月至2008年1月住院并确诊巨细胞动脉炎患者的临床资料。研究结果:我院1983年1月～2008年1月住院治疗的巨细胞动脉炎患者26例,男女比例1:1,发病年龄50～82（65.77±7.34）岁,临床表现以发热、新发头痛、颞动脉病变最为多见;实验室检查有血沉（Erythrosedimentation,ESR）、C反应蛋白（C-reactiveprotein,CRP）明显升高,贫血,白细胞（Leucocyte,WBC）和血小板（Platelet,PLT）升高以及血浆白蛋白（Plasma-albumin,ALB）降低,全身大血管彩色多普勒超声、CT、MRI可以发现血管狭窄病变;为提高病理阳性率,建议在糖皮质激素治疗前进行颞动脉活检（Temporal artery biopsy,TAB）（P=0.032）,合并风湿性多肌痛（Polymyalgia rheumatica,PMR）（P=0.02）、ESR≥100mm/hr（P=0.02）可以作为预测病理阳性的指标;糖皮质激素治疗是肯定的,但联合免疫抑制剂治疗,对减少复发尚无统计学意义。不伴头痛患者复发率高于伴有头痛患者（P=0.045）;感染是最主要的死因。结论:巨细胞动脉炎多发生于年老患者,男女发病率无差别,误诊率高,临床表现以发热、新发头痛、颞动脉病变多见。全身大血管彩色多普勒超声、CT、MRI可作为无创检查发现血管病变。合并PMR、ESR可作为预测病理阳性结果的指标。糖皮质激素治疗有效。头痛可作为预测复发的指标。重视病人教育。
论文目录
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