巨细胞动脉炎的临床表型:洞察并发症和生存结果。

IF 1.3 Q4 RHEUMATOLOGY
Paula Estrada, Javier Narváez, Patricia Moya, Daniel Roig-Vilaseca, Oscar Camacho, Vanessa Navarro, Sergi Heredia, Dacia Cerdà, Delia Reina, Hèctor Corominas
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引用次数: 0

摘要

背景:巨细胞动脉炎(GCA)是一种异质性疾病,临床表现多种多样,严重程度也各不相同。本研究旨在评估 GCA 中 3 种临床亚型的发病率,并分析相关的严重并发症和存活率。通过确定不同的临床模式,目的是在随访过程中定制治疗方法并最大限度地减少严重并发症:这项回顾性研究根据就诊原因将 GCA 的临床表现分为 3 大表型:i) 颅内型;ii) 颅外型;iii) 隐性 GCA。研究人员对这些组别的急性并发症(包括严重缺血性并发症)、"真正的 "闭塞性疾病以及主动脉瘤等晚期并发症进行了分析和比较。此外,还收集了随访期间的生存数据:结果:与其他亚组相比,颅内 GCA 组的视力障碍更为常见(P < .001)。失明和中风显示出与临床相关的趋势,但颅内 GCA 组之间的统计差异并不显著。与颅内或隐匿性 GCA 亚组相比,颅外亚组的肢体跛行发生率明显更高(分别为 12% vs. 2.6% vs. 0%)。严重缺血性并发症和真正的闭塞性疾病在颅内 GCA 组中更为常见(分别为 60%,P=.005 和 40%,P=1.64)。在死亡率方面,不同临床亚组的存活率没有显著的统计学差异。然而,隐匿性GCA亚组显示出较高的死亡发生率趋势,无论是总体死亡还是因GCA导致的死亡:结论:GCA 的临床亚群呈现出不同的并发症和生存结果,颅内亚群显示出较高的严重缺血事件发生率,而隐匿亚群则与诊断延迟和死亡率增加有关。识别这些亚群对于采取有针对性的治疗方法和改善患者预后至关重要。需要进一步开展前瞻性研究,以完善诊断和治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Phenotypes of Giant Cell Arteritis: Insights into Complications and Survival Outcomes.

Background: Giant cell arteritis (GCA) is a heterogeneous disease with diverse clinical presentations and varying degrees of severity. This study aimed to assess the incidence of 3 clinical subsets in GCA and analyze associated severe complications and survival rates. By identifying distinct clinical patterns, the goal is to customize treatment approaches and minimize severe complications during follow-up.

Methods: This retrospective study classified clinical manifestations of GCA into 3 major phenotypes based on the reason for consultation: i) cranial, ii) extracranial, and iii) occult GCA. These groups were analyzed and compared for acute complications, including severe ischemic complications, "true" occlusive disease, and late complications such as aortic aneurysm. Survival data were also collected during follow-up.

Results: Visual disturbances were more common in the cranial GCA group compared to other subsets (P < .001). Blindness and stroke showed a clinically relevant trend, although statistical differences were not significant between the cranial GCA groups. Limb claudication was significantly more prevalent in the extracranial subset compared to the cranial or occult GCA subsets (12% vs. 2.6% vs. 0% respectively). Severe ischemic complications and true occlusive disease were more frequent in the cranial GCA groups (60%, P=.005 and 40%, P=1.64 respectively). Regarding mortality, there were no statistically significant differences in survival among the different clinical subsets. However, the occult GCA subset showed a trend towards a higher prevalence of deaths, both overall and specifically due to GCA.

Conclusion: Clinical subsets in GCA present distinct complications and survival outcomes, with the cranial subset showing a higher incidence of severe ischemic events and the occult subset associated with delayed diagnosis and increased mortality. Recognizing these subsets is crucial for tailored treatment approaches and improving patient prognosis. Further prospective studies are needed to refine diagnostic and therapeutic strategies.

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