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程昉,邵壮,陈浩扬,赵福涛,高洁,蔡青.大动脉炎397例临床特征分析:性别和年龄差异分布[J].Academic Journal of Second Military Medical University ,2019,40(6):608-613
大动脉炎397例临床特征分析:性别和年龄差异分布    点此下载全文 Fulltext
程昉1  邵壮2  陈浩扬3  赵福涛1  高洁2  蔡青2*
1. 上海交通大学医学院附属第九人民医院风湿免疫科, 上海 201999;
2. 海军军医大学(第二军医大学)
长海医院风湿免疫科, 上海 200433;
3. 上海杨思医院门诊部, 上海 200126
*通信作者
基金项目:
DOI:10.16781/j.0258-879x.2019.06.0608
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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%),χ2=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)vs 16.5%(55/333),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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),χ2=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。
关键词:Takayasu动脉炎  临床特征  性别分布  年龄分布
Clinical features of 397 patients with Takayasu arteritis: gender and age distribution    Fulltext
CHENG Fang1  SHAO Zhuang2  CHEN Hao-yang3  ZHAO Fu-tao1  GAO Jie2  CAI Qing2*
1. Department of Rheumatology and Immunology, Ninth People's Hospital of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China;
2. Department of Rheumatology and Immunology, Changhai Hospital, Naval Medical University(Second Military Medical University)
, Shanghai 200433, China;
3. Department of Outpatient, Shanghai Yangsi Hospital, Shanghai 200126, China
*Corresponding author
Fund Project:
Abstract:
      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 female patients, 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 (χ2=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], χ2=7.605, P<0.01) and less frequently with dizziness, headache and syncope (28.1%[18/64] vs 46.5%[155/333], χ2=7.409, P<0.01). During the course of disease, hypertension was more prevalent (70.3%[45/64] vs 56.8%[189/333], χ2=4.076, P<0.05) and diminished or absent pulse was less common (51.6%[33/64] vs 76.0%[253/333], χ2=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], χ2=5.997, P<0.05) and a lower incidence of diminished or absent pulse (40.4%[19/47] vs 82.4%[14/17], χ2=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]; χ2=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]; χ2=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]; χ2=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], χ2=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]; χ2=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.
Keywords:Takayasu arteritis  clinical features  sex distribution  age distribution
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