大动脉炎合并外周动脉受累的临床特点分析

摘要

目的 总结大动脉炎合并外周动脉受累患者的临床特点.方法 回顾性分析2012年1月至2017年6月在首都医科大学附属北京安贞医院住院的32例大动脉炎合并外周动脉病变患者的临床资料.分析比较患者的一般资料、主要症状及体征、影像学检查及实验室检查结果.结果 32例患者中男6例、女26例,男女比例约为1∶4.男、女患者年龄差异无统计学意义[(35±12)岁比(39±14)岁](P=0.599).21例(65.6％)患者接受糖皮质激素治疗;18例(56.3％)患者合用免疫抑制剂;8例(25.0％)患者使用生物制剂;17例(53.1％)患者加用抗血小板药物治疗.患者的临床症状、体征以头晕(18例,56.2％)、四肢乏力(14例,43.8％)、无脉(13例,40.6％)、四肢血压不对称(11例,34.4％)为主要表现.影像分型以Ⅴ型最常见(19例,59.4％),其次为Ⅰ型(6例,18.8％).受累的外周动脉以腋动脉(20例,62.5％)、股动脉(13例,40.6％)为主.病变性质表现为受累动脉的狭窄(22例,68.8％)、闭塞(10例,31.3％)、内中膜增厚(5例,15.6％)、动脉瘤形成(1例,3.1％).男、女患者临床表现、影像分型、病变部位及病变性质差异均无统计学意义(均P＞0.05).实验室指标中,红细胞沉降率增快者13例(40.6％),均为女性;C反应蛋白升高者12例(37.5％),女性多见(11例,42.3％).结论 大动脉炎可导致外周动脉病变,临床医师应关注头晕、四肢乏力、无脉、四肢血压不对称、影像分型为V型患者的外周动脉受累情况.大动脉炎男、女患者外周动脉受累时临床症状及体征、临床分型、病变部位及性质无明显差异.%Objective To investigate the clinical features of Takayasu's arteritis with peripheral artery involvement.Methods Clinical records of 32 patients with Takayasu's arteritis and peripheral artery lesions in Beijing Anzhen Hospital,Capital Medical University from January 2012 to June 2017 were reviewed.General information,main symptoms and signs,imaging and laboratory results were analyzed.Results There were 6 males and 26 females;the male to female ratio was about 1 ∶ 4.There was no significant difference of age between males and females[(35 ± 12)years vs(39 ± 14)years] (P =0.599).Twenty-one(65.6％) patients were treated with glucocorticoids;18 (56.3％) patients were treated with immunosuppressants;8 (25.0％) patients were treated with biological agents;17 (53.1％) patients were treated with antiplatelet agents.Common clinical manifestations were dizziness (n =18,56.2％),limb weakness (n =14,43.8％),pulselessness (n =13,40.6％) and asymmetric blood pressure of limbs (n =11,34.4％).According to angiographic manifestations,type Ⅴ (n =19,59.4％) and type Ⅰ (n =6,18.8％) were the most common types.Peripheral lesions mainly located at axillary artery(n =20,62.5％) and femoral artery(n =13,40.6％).The lesions were characterized by angiostenosis(n =22,68.8％),occlusion (n =10,31.3％),intima-media thickness increase (n =5,15.6％)and aneurysm (n =1,3.1％).There were no significant differences of clinical manifestations,angiographic classifications,lesion locations and characteristics between males and females (P ＞ 0.05).Among laboratory indicators,13 female patients (40.6％) showed erythrocyte sedimentation rate increase;12 patients (37.5％)showed C-reactive protein level increase,including 11 females (42.3％) and 1 male.Conclusions Peripheral artery lesions can be involved in Takayasu's arteritis.Common clinical manifestations of Takayasu's arteritis with peripheral artery involvement are dizziness,limb weakness,pulselessness and asymmetric blood pressure in limbs.There are no significant differences of clinical manifestations,angiographic classifications,lesion locations and characteristics between male and female patients.