中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2009年
9期
612-615
,共4页
赖晋智%徐东%李梦涛%田庄%张抒扬%方全%曾小峰
賴晉智%徐東%李夢濤%田莊%張抒颺%方全%曾小峰
뢰진지%서동%리몽도%전장%장서양%방전%증소봉
Takayasu动脉炎%高血压,肺性%治疗
Takayasu動脈炎%高血壓,肺性%治療
Takayasu동맥염%고혈압,폐성%치료
Takayasu's arteritis%Hypertension,pulmonary%Therapy
目的 分析大动脉炎(TA)合并肺动脉高压(PAH)的临床特点,以提高临床早期诊治的水平.方法 1987-2007年北京协和医院住院治疗的TA患者共191例,对其中合并PAH的12例患者的临床表现、实验窒检查及治疗、预后进行回顾性分析.结果 12例患者中女性10例,男性2例.年龄14~47岁,平均(27±10)岁.11例有肺血管受累的临床表现和(或)体征,7例以肺血管受累表现(活动后气短、咯血)为首发症状,其他首发表现分别为发热4例,乏力4例,四肢缺血表现(下肢间歇性跛行、上肢痛、肢体麻木)4例,头晕3例.12例患者中7例为Ⅰ+Ⅳ型、1例为Ⅱ+Ⅳ型、3例为Ⅲ+Ⅳ型、1例为Ⅳ型.10例患者有炎性指标[红细胞沉降率(ESR)、C反应蛋白(CRP)]明显升高,ESR(66±56)mm/1 h.所有的患者均接受激素及免疫抑制剂治疗,1例行支架植入术,1例接受手术治疗.除1例因术后低心排出量死亡外,其余患者症状均好转.结论 PAH为大动脉炎累及肺血管的晚期及严重并发症,常合并有全身其他部位血管受累.早期因起病隐匿不易引起重视,应行肺血管造影、CTA或心脏超声进行早期筛查,早期治疗.治疗上除激素、免疫抑制剂治疗原发病外,当血管重度狭窄时可行支架植入或血管扩张术.
目的 分析大動脈炎(TA)閤併肺動脈高壓(PAH)的臨床特點,以提高臨床早期診治的水平.方法 1987-2007年北京協和醫院住院治療的TA患者共191例,對其中閤併PAH的12例患者的臨床錶現、實驗窒檢查及治療、預後進行迴顧性分析.結果 12例患者中女性10例,男性2例.年齡14~47歲,平均(27±10)歲.11例有肺血管受纍的臨床錶現和(或)體徵,7例以肺血管受纍錶現(活動後氣短、咯血)為首髮癥狀,其他首髮錶現分彆為髮熱4例,乏力4例,四肢缺血錶現(下肢間歇性跛行、上肢痛、肢體痳木)4例,頭暈3例.12例患者中7例為Ⅰ+Ⅳ型、1例為Ⅱ+Ⅳ型、3例為Ⅲ+Ⅳ型、1例為Ⅳ型.10例患者有炎性指標[紅細胞沉降率(ESR)、C反應蛋白(CRP)]明顯升高,ESR(66±56)mm/1 h.所有的患者均接受激素及免疫抑製劑治療,1例行支架植入術,1例接受手術治療.除1例因術後低心排齣量死亡外,其餘患者癥狀均好轉.結論 PAH為大動脈炎纍及肺血管的晚期及嚴重併髮癥,常閤併有全身其他部位血管受纍.早期因起病隱匿不易引起重視,應行肺血管造影、CTA或心髒超聲進行早期篩查,早期治療.治療上除激素、免疫抑製劑治療原髮病外,噹血管重度狹窄時可行支架植入或血管擴張術.
목적 분석대동맥염(TA)합병폐동맥고압(PAH)적림상특점,이제고림상조기진치적수평.방법 1987-2007년북경협화의원주원치료적TA환자공191례,대기중합병PAH적12례환자적림상표현、실험질검사급치료、예후진행회고성분석.결과 12례환자중녀성10례,남성2례.년령14~47세,평균(27±10)세.11례유폐혈관수루적림상표현화(혹)체정,7례이폐혈관수루표현(활동후기단、각혈)위수발증상,기타수발표현분별위발열4례,핍력4례,사지결혈표현(하지간헐성파행、상지통、지체마목)4례,두훈3례.12례환자중7례위Ⅰ+Ⅳ형、1례위Ⅱ+Ⅳ형、3례위Ⅲ+Ⅳ형、1례위Ⅳ형.10례환자유염성지표[홍세포침강솔(ESR)、C반응단백(CRP)]명현승고,ESR(66±56)mm/1 h.소유적환자균접수격소급면역억제제치료,1례행지가식입술,1례접수수술치료.제1례인술후저심배출량사망외,기여환자증상균호전.결론 PAH위대동맥염루급폐혈관적만기급엄중병발증,상합병유전신기타부위혈관수루.조기인기병은닉불역인기중시,응행폐혈관조영、CTA혹심장초성진행조기사사,조기치료.치료상제격소、면역억제제치료원발병외,당혈관중도협착시가행지가식입혹혈관확장술.
Objective To investigate the clinical characteristics of Takayasu's arteritis (TA) with pulmonary hypertension (PAH) in order to improve the diagnosis and treatment earlier. Methods Twelve out of 191 patients with TA registered in Peking Union Medical College Hospital from 1987 to 2007 were diagnosed as PAH, the clinical data of 12 patients were analyzed. Results Ten patients were females. The range of age were from 14 to 47 years old, the average age was (27±10) years old. Eleven patients had the clinical manifestations or/and signs of pulmonary artery involvement. Seven patients presented with short breath after exercise or hemoptysis as the first manifestation, four patients with fatigue, four patients with intermittent claudication or pain or numbness of extremities, three patients with dizziness. Seven patients belonged to type Ⅰ+Ⅳ, one patient to type Ⅱ+Ⅳ, three patients to type Ⅲ+Ⅳ, one patient to type Ⅴ. Elevated ESR/CRP was found in ten patients. All patients took the glucocorticoid and DMARDs, stent implantation in pulmonary artery was done in one patient, Bentall was operated in another patient.The symptoms of all patients improved except one patient died for low cardiac output after operation. Conclusion PAH is one of the severe complications in late stage of TA, and other arteries are usually involved too. Because it is difficult to observe PAH in TA patients in early stage, CTA or pulmonary angiography and UCG should be taken in early stage. The stent implantation or dilating the artery should be considered aa a treatment, but at on the same time, glucocorticoid and DMARDs should be taken to avoid the relapse.