摘要 【据《Medicine (Baltimore)》2011年1月报道】题：对36例巨细胞动脉炎相关性上/下肢血管炎患者的长期随访研究（作者Assie C等） 最近，法国卢昂大学医院内科的Assie C等对非动脉粥样硬化性上肢和/或下肢动脉病变患者进行了一项回顾性研究，旨在确定巨细胞动脉炎(GCA)的发生率，并分析GCA相关性上/下肢血管炎患者的临床特点和转归。

1997年1月～2008年3月，在Rouen大学医疗中心内科，共有36例患者确诊为GCA相关性上下肢血管炎。其中，上/下肢血管炎发生在GCA确诊之前的有7例（19.4%），与GCA同时发病的有13例（36.1%），在GCA确诊之后发生的为16例（44.4%）。10例患者（27.8%）的GCA临床表现严重，导致肢体缺血的并发症。GCA相关性大血管损伤仅累及上肢的有21例（58.3%），仅累及下肢的有7例（19.4%），上下肢同时受累的有8例（22.2%）。GCA相关性上肢血管炎患者受累的动脉包括锁骨下动脉（55.6%）、腋动脉（47.2%）和肱动脉（22.2%）。GCA相关性下肢血管炎患者受累的动脉包括髂内动脉（11.1%）、股总动脉（13.9%）、股浅动脉（33.3%）、股深动脉（5.6%），腘动脉和胫前动脉（5.6%）。GCA相关性上/下肢血管炎患者中主动脉受累很常见（68.9%）。所有的患者均接受激素治疗，中位初始药物剂量为1mg/kg。10例患者（27.8%）进行重建手术：静脉搭桥术（6例）、血管成形术（1例）、血栓内膜剥脱术（2例）和血栓清除术（1例），还有2例肢体缺血的患者进行了截肢手术。中位观察期为32个月；上/下肢血管炎的转归包括临床症状消失（44.4%）、改善（44.4%）和恶化（11.1%）。末次随访时，强的松中位用量为6mg/天。12例患者（33.3%）停用了激素。

本研究发现，GCA患者伴上/下肢血管炎并非罕见，且可出现在GCA的早期急性期。由于上/下肢血管炎可发生在GCA病程中，因此每年进行临床血管检查足以在GCA早期阶段发现上/下肢血管炎。早期诊断GCA关性上/下肢血管炎至关重要，可以减少严重肢体缺血性并发症的发生。由于大动脉受累常见，GCA相关性上/下肢血管炎患者应接受常规检查以排除具有潜在生命危险的大动脉相关并发症（大动脉扩张和大动脉瘤）。研究人员同时建议对伴有大动脉相关并发症的GCA患者进行常规的临床血管检查以及时发现上/下肢血管炎。

附原文： We conducted this retrospective study to determine the prevalence of giant cell arteritis (GCA) in patients exhibiting nonatherosclerotic upper and/or lower extremity arterial involvement and to evaluate the clinical features and long-term outcome of those patients.From January 1997 to March 2008, 36 consecutive patients in the Department of Internal Medicine at the University of Rouen medical center received a diagnosis of symptomatic upper/lower extremity vasculitis related to GCA. In the 36 patients, upper/lower extremity vasculitis preceded the initial GCA diagnosis in 7 patients (19.4%), it was identified in association with GCA in 13 patients (36.1%), and it developed after the onset of GCA in the remaining 16 patients (44.4%). GCA clinical manifestations were severe resulting in ischemic complications of the extremities in 10 patients (27.8%). GCA-related large-vessel involvement was located in the upper extremity alone in 21 patients (58.3%), the lower extremity alone in 7 patients (19.4%), and both the upper and lower extremities in 8 patients (22.2%).Arterial involvement in GCA patients with upper extremity vasculitis was distributed in the subclavian (55.6%), axillary (47.2%), and brachial (22.2%) arteries. In patients with lower extremity vasculitis, involvement included the internal iliac artery (11.1%), common femoral artery (13.9%), superficial femoral artery (33.3%), deep femoral artery (5.6%), and popliteal and anterior tibial arteries (5.6%). Aortic localizations were common in GCA patients with upper/lower extremity vasculitis (68.9% of cases).All patients were given steroid therapy at a median daily dose of 1 mg/kg initially. Reconstructive study was performed in 10 patients (27.8%): venous bypass graft (n = 6), angioplasty (n = 1), thromboendarteriectomy (n = 2), or thrombectomy (n = 1); 2 other patients with extremity ischemia underwent amputation. The median observation time was 32 months; the outcome of upper/lower extremity vasculitis was disappearance of clinical symptoms (44.4%), improvement of clinical manifestations (44.4%), and deterioration of clinical manifestations (11.1%). At last follow-up, the median daily dose of prednisone was 6 mg. Steroid therapy could be discontinued in 12 patients (33.3%).We found that upper/lower extremity vasculitis is not uncommon in patients with GCA, and may be present in the early acute phase of GCA. Nevertheless, because upper/lower extremity vasculitis occurs during the course of GCA, yearly clinical vascular examinations may be adequate to screen for upper/lower extremity vasculitis at an early stage in GCA patients. Early diagnosis of GCA-related upper/lower extremity vasculitis is crucial, and can result in decreased severe ischemic complications. Because aortic localizations were common, GCA patients with upper/lower extremity vasculitis should undergo routine investigations for underlying life-threatening aortic complications (aortic ectasia/aneurysm). We also suggest that patients exhibiting aortic complications should undergo routine clinical vascular examination to detect upper/lower extremity vasculitis.

引自: Assie C, Janvresse A, Plissonnier D, Levesque H, Marie I. Long-term follow-up of upper and lower extremity vasculitis related to giant cell arteritis: a series of 36 patients. Medicine (Baltimore). 2011 Jan;90(1):40-51.