31例巨细胞动脉炎临床分析并文献复习

目的总结巨细胞动脉炎的临床特点，提高临床医师认识，以达到早期诊断、有效治疗。方法根据美国风湿病学学会（ACR）分类标准诊断为巨细胞动脉炎（GCA）的解放军总医院的住院患者31例，对其临床特点、实验室检查、预后进行分析总结。并与国外文献报道进行对比分析。结果本组31例，男17例，女14例，年龄47-92岁，平均67．1岁。急性起病者20例。有头痛者29例、乏力者27例、发热者25例、风湿性多肌痛17例、体质量下降者15例、咀嚼困难12例、视力改变8例。颞动脉形态异常15例，搏动异常者16例。脑部CT可见梗死灶（包括腔隙性脑梗死）21例；颞动脉超声异常22例。初诊红细胞沉降率50～150mm／h，平均（81±26）mm／h；治疗2周后红细胞沉降率2～43mrn／h，平均（19±12）mm／h。综合国内文献，中国人GCA不同于国外，男性发病比例高于女性，且发热、体质量下降等全身症状较突出。结论本组患者及国人GCA不同于国外文献报道，男性多发；常见表现也多为发热、头痛、风湿性多肌痛，对激素治疗反应较好。超声检查是明确诊断、评判治疗效果的有效手段。

Giant cell arteritis clinical characteristics of 31 cases and literature review

Objective To investigate the clinical features of giant cell arteritis（GCA）. Methods Data of 31 patients with GCA （diagnosed according to American College of Rheumatology classification standard） in Chinese PLA General Hospital from 2008 to 2011 were analyzed. The clinical manifestation, assistant examinations, response to steroid therapy and follow-up data were recorded and compared with results in literatures abroad. Results There were 17 male cases and 14 female cases and mean age was 67.1 years （range 47-92 years） and 20 cases were acute onset. There were 29 cases with headache, 27 cases with weakness, 25 cases with fever, 17 cases with rheumatic polymyalgia, 15 cases with weight loss, 12 cases with dysmasesia, and 15 cases with temporal artery abnormal morphology and pulsation. Brain CT showed infarctions（including lacunar infarction） in 21 cases and temporal artery ultrasound showed abnormity in 22 cases. Erythrocyte sedimentation rate at first visit was 98.3 mm/h（50--150 rnm/h） and increased to 18.5 mm/h （20-43 mmlh）. Incidence in male was higher than that in female according to reports in China, which was different from reports abroad, those in and constitutional symptoms, such as fever and weight loss are prominent. Conelutions Characteristis of GCA patients in China are different from those in other countries. The male incidence is higher than female, and fever, headache, rheumatic polymyalgia are more common. Ultrasound is an effective means in diagnosis and clinical evaluation.