大动脉炎合并脑梗死49例临床分析

目的 总结大动脉炎合并脑梗死患者的临床特点，分析此类患者脑梗死复发的相关因素。方法 回顾性分析2010年1月-2020年6月随访超过3年的大动脉炎合并脑梗死患者的临床资料，对此类患者脑梗死复发的相关因素进行分析。结果 共纳入49例患者，首次脑梗死中位年龄30.0（22.0～45.0）岁，中位随访时间3.4（3.2～3.7）年。11例（22.4%）出现复发性脑梗死，两次脑梗死间隔中位时间8.0（5.0～88.0）个月。与脑梗死无复发患者相比，复发性脑梗死患者合并糖尿病比例（27.3% vs 2.6%，P =0.031）以及首次脑梗死后随访期间平均TG水平（3.65±0.96 mmol/L vs 1.14±0.54 mmol/L，P =0.001）升高。大动脉炎受累动脉以颈总动脉最为常见（48/49，98%），其次是椎动脉（40/49，81.6%），受累血管病变性质以狭窄（49/49，100%）和闭塞（36/49，73.5%）最常见。脑梗死复发组动脉闭塞比例（100% vs 65.8%，P =0.024）和动脉血栓发生率（45.5% vs 13.2%，P =0.033）均高于脑梗死无复发组。治疗方面，脑梗死复发组抗血小板治疗患者比例（63.6% vs 97.4%，P =0.007）及接受血管重建术的患者比例（27.3% vs 68.4％，P =0.033）均低于脑梗死无复发组。结论 大动脉炎合并脑梗死的患者，如合并糖尿病、血脂控制欠佳、主动脉弓分支动脉有闭塞、血栓形成者，脑梗死复发风险高。

Clinical Analysis of 49 Cases of Takayasu Arteritis Complicated with Cerebral Infarction

Objective To summarize the clinical features of Takayasu arteritis (TA) complicated with cerebralinfarction (CI), and analyze the related factors for recurrent cerebral infarction in TA patients.Methods The clinical data of 49 patients with TA and CI who were followed up for more than 3years from January 2010 to June 2020 were retrospectively analyzed.Results A total of 49 eligible patients were included. The median age at the first CI onset was 30.0(22.0-45.0) years old, and the median follow-up time was 3.4 (3.2-3.7) years. Recurrent cerebralinfarction occurred in 11 cases (22.4%), and the median time between the two CI was 8.0 (5.0-88.0)months. The proportion of diabetes mellitus (27.3% vs 2.6%, P =0.031) and the elevated triglyceridelevel during the follow-up after CI (3.65±0.96 mmol/L vs 1.14±0.54 mmol/L, P =0.001) in patientswith recurrent CI were significantly higher than that in those without recurrent CI. The most involvedartery in TA was common carotid artery (48/49, 98%), followed by vertebral artery (40/49, 81.6%),stenosis (49/49, 100%) and occlusion (36/49, 73.5%) were the most common lesions in these involvedarteries. The incidence of artery occlusion (100% vs 65.8%, P =0.024) and thrombosis (45.5% vs13.2%, P =0.033) in patients with recurrent CI were significantly higher than that in those withoutrecurrent CI. The patients with recurrent CI had lower proportion of receiving antiplatelet therapy (63.6% vs 97.4%, P =0.007) and revascularization (27.3% vs 68.4%, P =0.033) than those withoutrecurrent CI.Conclusions Diabetes mellitus, poor lipid control, occlusion in branches of aortic arch andthrombosis were correlated with recurrent CI risk in patients with TA and CI.