大动脉炎397例临床特征分析:性别和年龄差异分布
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摘要
目的探讨不同性别和年龄大动脉炎患者临床特征的差异。方法回顾性分析2001年1月至2017年12月海军军医大学(第二军医大学)长海医院收治的397例大动脉炎患者的病历资料,比较男女患者及不同性别中≤40岁和> 40岁患者的临床表现、并发症、实验室检查和影像学检查结果的差异。结果 397例大动脉炎患者中男64例、女333例(男女比例为1∶5.2),发病年龄为2～67岁。> 40岁男性大动脉炎患者多于女性[17例(26.6%)vs 53例(15.9%),χ~2=4.190,P=0.041]。相比女性患者,男性患者首发症状以高血压最多见[31.2%(20/64) vs16.5%(55/333),χ~2=7.605,P <0.01],而以头晕、头痛或晕厥起病者较少[28.1%(18/64)vs 46.5%(155/333),χ~2=7.409,P <0.01]。病程中,男性患者较女性患者更常出现高血压[70.3%(45/64)vs 56.8%(189/333),χ~2=4.076,P <0.05],较少发生脉搏减弱或消失[51.6%(33/64)vs 76.0%(253/333),χ~2=15.885,P <0.01];男性发病年龄≤40岁的患者较> 40岁者高血压的发生率更高[78.7%(37/47)vs 47.1%(8/17),χ~2=5.997,P <0.05],而脉搏减弱或消失的发生率较低[40.4%(19/47)vs 82.4%(14/17),χ~2=8.787,P<0.01]。男性患者并发动脉瘤形成、主动脉瓣反流的比例较女性患者更高[39.1%(25/64)vs 17.4%(58/333)、23.4%(15/64)vs 10.8%(36/333),χ~2=15.210、7.644,P均<0.01]。男女患者及各年龄亚组之间红细胞沉降率升高和C-反应蛋白升高的患者比例差异均无统计学意义(P均>0.05)。在血管受累及临床分型方面,相比女性患者,男性患者常见肾动脉受累和Ⅳ型[54.7%(35/64)vs 32.7%(109/333)、32.8%(21/64)vs 18.9%(63/333),χ~2=11.194、6.212,P均<0.05],颈总动脉受累、锁骨下动脉受累和Ⅰ型较少见[37.5%(24/64)vs 64.3%(214/333)、37.5%(24/64)vs 56.5%(188/333)、21.9%(14/64)vs 42.3%(141/333),χ~2=16.016、8.416、9.449,P均<0.01];男性发病年龄≤40岁的患者较>40岁者更常见Ⅳ型[44.7%(21/47)vs 0(0/17),χ~2=11.305,P <0.01],颈总动脉受累、锁骨下动脉受累和Ⅰ型较少见[29.8%(14/47)vs 58.8%(10/17),25.5%(12/47)vs 70.6%(12/17),14.9%(7/47)vs 41.2%(7/17),χ~2=4.491、10.814、5.046,P均<0.05]。结论男性大动脉炎患者发病晚于女性,男性患者尤其发病年龄≤40岁的患者以高血压和肾动脉受累(Ⅳ型)多见,女性和发病年龄> 40岁的男性患者常见脉搏减弱或消失和颈总动脉、锁骨下动脉受累(Ⅰ型),并发高血压、动脉瘤形成和主动脉瓣反流的男性患者多于女性患者。
Objective To investigate the clinical features of Takayasu arteritis patients with different genders and ages. Methods The medical charts of 397 patients diagnosed with Takayasu arteritis in Changhai Hospital, Naval Medical University(Second Military Medical University) between Jan. 2001 and Dec. 2017 were retrospectively reviewed. The clinical manifestations, complications, laboratory parameters and imaging findings were compared between male and femalepatients, and between the groups subdivided by the ages of onset(≤40 years vs >40 years). Results There were 64 males and 333 females, with a male to female ratio of 1∶5.2. The age of disease onset was 2-67 years. Seventeen(26.6%) male patients and 53(15.9%) female patients had disease onset after 40(χ~2=4.190, P=0.041). Compared with female patients, male patients had their onset more frequently with hypertension(31.2% [20/64] vs 16.5% [55/333], χ~2=7.605, P<0.01) and less frequently with dizziness, headache and syncope(28.1% [18/64] vs 46.5% [155/333], χ~2=7.409, P<0.01). During the course of disease, hypertension was more prevalent(70.3% [45/64] vs 56.8% [189/333], χ~2=4.076, P<0.05) and diminished or absent pulse was less common(51.6% [33/64] vs 76.0% [253/333], χ~2=15.885, P<0.01) in male patients. Male patients with onset age ≤40 years(versus >40 years) had a higher incidence of hypertension(78.7% [37/47] vs 47.1% [8/17], χ~2=5.997, P<0.05) and a lower incidence of diminished or absent pulse(40.4% [19/47] vs 82.4% [14/17], χ~2=8.787, P<0.01). The complication rates of aneurysm and aortic regurgitation were significantly higher in male patients versus female patients(39.1% [25/64] vs 17.4% [58/333], 23.4% [15/64] vs 10.8% [36/333]; χ~2=15.210, 7.644; both P<0.01). The prevalence rates of elevated erythrocyte sedimentation rate or C-reactive protein were similar between different gender and onset age groups(all P>0.05). Angiographically, male patients had more renal artery involvement and type Ⅳ(54.7% [35/64] vs 32.7% [109/333], 32.8% [21/64] vs 18.9% [63/333]; χ~2=11.194, 6.212; both P<0.05) and less carotid artery and subclavian artery lesions and type Ⅰ(37.5% [24/64] vs 64.3% [214/333], 37.5% [24/64] vs 56.5% [188/333], 21.9% [14/64] vs 42.3% [141/333]; χ~2=16.016, 8.416, 9.449; all P<0.01) compared with female patients. Male patients with onset age ≤40 years(versus >40 years) had a higher proportion of type Ⅳ(44.7% [21/47] vs 0 [0/17], χ~2=11.305, P<0.01) and lower proportions of carotid artery and subclavian artery lesions and type Ⅰ(29.8% [14/47] vs 58.8% [10/17], 25.5% [12/47] vs 70.6% [12/17], 14.9% [7/47] vs 41.2% [7/17]; χ~2=4.491, 10.814, 5.046; all P<0.05). Conclusion Male Takayasu arteritis patients have a later onset age compared with female patients. Hypertension and renal artery involvement(type Ⅳ) are commonly seen in male patients with onset age ≤40 years; female patients and male patients with onset age >40 years often have diminished or absent pulse and carotid artery and subclavian artery lesions(type Ⅰ). The complications such as hypertension, aneurysm and aortic regurgitation are more common in male patients compared with female patients.
Objective To investigate the clinical features of Takayasu arteritis patients with different genders and ages. Methods The medical charts of 397 patients diagnosed with Takayasu arteritis in Changhai Hospital, Naval Medical University(Second Military Medical University) between Jan. 2001 and Dec. 2017 were retrospectively reviewed. The clinical manifestations, complications, laboratory parameters and imaging findings were compared between male and femalepatients, and between the groups subdivided by the ages of onset(≤40 years vs >40 years). Results There were 64 males and 333 females, with a male to female ratio of 1∶5.2. The age of disease onset was 2-67 years. Seventeen(26.6%) male patients and 53(15.9%) female patients had disease onset after 40(χ~2=4.190, P=0.041). Compared with female patients, male patients had their onset more frequently with hypertension(31.2% [20/64] vs 16.5% [55/333], χ~2=7.605, P<0.01) and less frequently with dizziness, headache and syncope(28.1% [18/64] vs 46.5% [155/333], χ~2=7.409, P<0.01). During the course of disease, hypertension was more prevalent(70.3% [45/64] vs 56.8% [189/333], χ~2=4.076, P<0.05) and diminished or absent pulse was less common(51.6% [33/64] vs 76.0% [253/333], χ~2=15.885, P<0.01) in male patients. Male patients with onset age ≤40 years(versus >40 years) had a higher incidence of hypertension(78.7% [37/47] vs 47.1% [8/17], χ~2=5.997, P<0.05) and a lower incidence of diminished or absent pulse(40.4% [19/47] vs 82.4% [14/17], χ~2=8.787, P<0.01). The complication rates of aneurysm and aortic regurgitation were significantly higher in male patients versus female patients(39.1% [25/64] vs 17.4% [58/333], 23.4% [15/64] vs 10.8% [36/333]; χ~2=15.210, 7.644; both P<0.01). The prevalence rates of elevated erythrocyte sedimentation rate or C-reactive protein were similar between different gender and onset age groups(all P>0.05). Angiographically, male patients had more renal artery involvement and type Ⅳ(54.7% [35/64] vs 32.7% [109/333], 32.8% [21/64] vs 18.9% [63/333]; χ~2=11.194, 6.212; both P<0.05) and less carotid artery and subclavian artery lesions and type Ⅰ(37.5% [24/64] vs 64.3% [214/333], 37.5% [24/64] vs 56.5% [188/333], 21.9% [14/64] vs 42.3% [141/333]; χ~2=16.016, 8.416, 9.449; all P<0.01) compared with female patients. Male patients with onset age ≤40 years(versus >40 years) had a higher proportion of type Ⅳ(44.7% [21/47] vs 0 [0/17], χ~2=11.305, P<0.01) and lower proportions of carotid artery and subclavian artery lesions and type Ⅰ(29.8% [14/47] vs 58.8% [10/17], 25.5% [12/47] vs 70.6% [12/17], 14.9% [7/47] vs 41.2% [7/17]; χ~2=4.491, 10.814, 5.046; all P<0.05). Conclusion Male Takayasu arteritis patients have a later onset age compared with female patients. Hypertension and renal artery involvement(type Ⅳ) are commonly seen in male patients with onset age ≤40 years; female patients and male patients with onset age >40 years often have diminished or absent pulse and carotid artery and subclavian artery lesions(type Ⅰ). The complications such as hypertension, aneurysm and aortic regurgitation are more common in male patients compared with female patients.
引文
[1]SHARMA B K,JAIN S.A possible role of sex in determining distribution of lesions in Takayasu arteritis[J].Int J Cardiol,1998,66(Suppl 1):S81-S84.
[2]WATANABE Y,MIYATA T,TANEMOTO K.Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan:age and sex specificity[J].Circulation,2015,132:1701-1709.
[3]邓小虎,黄烽.大动脉炎159例回顾性临床分析[J].中华风湿病学杂志,2006,10:39-43.
[4]AREND W P,MICHEL B A,BLOCH D A,HUNDERG G,CALABRESE L H,EDWORTHY S M,et al.The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis[J].Arthritis Rheum,1990,33:1129-1134.
[5]HATA A,NODA M,MORIWAKI R,NUMANO F.Angiographic findings of Takayasu arteritis:new classification[J].Int J Cardiol,1996,54(Suppl):S155-S163.
[6]ONEN F,AKKOC N.Epidemiology of Takayasu arteritis[J/OL].Presse Med,2017,46(7-8 Pt 2):e197-e203.doi:10.1016/j.lpm.2017.05.034.
[7]ARNAUD L,HAROCHE J,LIMAL N,TOLEDANO D,GAMBOTTI L,COSTEDOAT CHALUMEAU N,et al.Takayasu arteritis in France:a single-center retrospective study of 82 cases comparing white,North African,and black patients[J].Medicine(Baltimore),2010,89:1-17.
[8]YANG L,ZHANG H,JIANG X,ZOU Y,QIN F,SONG L,et al.Clinical manifestations and longterm outcome for patients with Takayasu arteritis in China[J].J Rheumatol,2014,41:2439-2446.
[9]LI J,SUN F,CHEN Z,YANG Y,ZHAO J,LI M,et al.The clinical characteristics of Chinese Takayasu’s arteritis patients:a retrospective study of 411 patients over 24 years[J/OL].Arthritis Res Ther,2017,19:107.doi:10.1186/s13075-017-1307-z.
[10]戴生明.巨细胞动脉炎和大动脉炎属于同一种疾病吗[J].中华风湿病学杂志,2017,21:553-555.
[11]YANG K Q,MENG X,ZHANG Y,FAN P,WANG LP,ZHANG H M,et al.Aortic aneurysm in Takayasu arteritis[J].Am J Med Sci,2017,354:539-547.
[12]万瑾,潘丽丽,慈维苹,郭衍秋,唐雪,王天.年龄40岁以上患者多发性大动脉炎发病的临床特征[J].中国医药,2013,8:1058-1060.
[13]中华医学会风湿病学分会.大动脉炎诊断及治疗指南[J].中华风湿病学杂志,2011,15:119-120.
[2]WATANABE Y,MIYATA T,TANEMOTO K.Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan:age and sex specificity[J].Circulation,2015,132:1701-1709.
[3]邓小虎,黄烽.大动脉炎159例回顾性临床分析[J].中华风湿病学杂志,2006,10:39-43.
[4]AREND W P,MICHEL B A,BLOCH D A,HUNDERG G,CALABRESE L H,EDWORTHY S M,et al.The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis[J].Arthritis Rheum,1990,33:1129-1134.
[5]HATA A,NODA M,MORIWAKI R,NUMANO F.Angiographic findings of Takayasu arteritis:new classification[J].Int J Cardiol,1996,54(Suppl):S155-S163.
[6]ONEN F,AKKOC N.Epidemiology of Takayasu arteritis[J/OL].Presse Med,2017,46(7-8 Pt 2):e197-e203.doi:10.1016/j.lpm.2017.05.034.
[7]ARNAUD L,HAROCHE J,LIMAL N,TOLEDANO D,GAMBOTTI L,COSTEDOAT CHALUMEAU N,et al.Takayasu arteritis in France:a single-center retrospective study of 82 cases comparing white,North African,and black patients[J].Medicine(Baltimore),2010,89:1-17.
[8]YANG L,ZHANG H,JIANG X,ZOU Y,QIN F,SONG L,et al.Clinical manifestations and longterm outcome for patients with Takayasu arteritis in China[J].J Rheumatol,2014,41:2439-2446.
[9]LI J,SUN F,CHEN Z,YANG Y,ZHAO J,LI M,et al.The clinical characteristics of Chinese Takayasu’s arteritis patients:a retrospective study of 411 patients over 24 years[J/OL].Arthritis Res Ther,2017,19:107.doi:10.1186/s13075-017-1307-z.
[10]戴生明.巨细胞动脉炎和大动脉炎属于同一种疾病吗[J].中华风湿病学杂志,2017,21:553-555.
[11]YANG K Q,MENG X,ZHANG Y,FAN P,WANG LP,ZHANG H M,et al.Aortic aneurysm in Takayasu arteritis[J].Am J Med Sci,2017,354:539-547.
[12]万瑾,潘丽丽,慈维苹,郭衍秋,唐雪,王天.年龄40岁以上患者多发性大动脉炎发病的临床特征[J].中国医药,2013,8:1058-1060.
[13]中华医学会风湿病学分会.大动脉炎诊断及治疗指南[J].中华风湿病学杂志,2011,15:119-120.