以缺血性卒中发病的大动脉炎15例临床特点分析

doi:10.3969/j.issn.1673-5765.2021.12.003

摘要/Abstract

摘要： 目的总结以缺血性卒中为首发症状的大动脉炎（Takayasu arteritis，TA）患者的临床特点。方法回顾性分析2010年1月-2021年8月首都医科大学宣武医院连续收治的TA合并缺血性卒中患者的临床资料，根据是否以缺血性卒中为首发症状，分为缺血性卒中发病组和其他症状发病组，比较两组间临床资料的差异，分析以缺血性卒中发病的TA患者的临床特点。结果最终纳入59例TA合并缺血性卒中患者，TA发病年龄8～51岁，平均29.7±13.1岁，男性7例（11.9%），缺血性卒中平均发病年龄35.8±14.1岁。15例（25.4%）患者以缺血性卒中为首发症状，首次卒中平均年龄低于其他症状发病患者（27.2±9.6岁 vs. 38.8±14.2岁，P =0.005）。缺血性卒中发病组患者与其他症状发病组比较，BMI较低（21.4±3.9 kg/m2 vs. 24.2±4.6 kg/m2，P＝0.039），合并高血压比例偏低（6.7% vs. 34.1%，P＝0.048），非特异性系统症状的发生率偏低（0 vs. 27.3%， P＝0.026），关节炎/关节痛比例较高（20.0% vs. 2.3%，P ＝0.047），血压不对称的发生率偏高（73.3% vs. 36.4%，P＝0.018），偏瘫发生率较高（93.3% vs. 59.1%，P =0.023），印度大动脉炎临床活动度评分2010（Indian Takayasu clinical activity score 2010，ITAS-2010）较高（12.2±5.4分 vs. 7.1±5.8 分，P＝0.004）。结论以缺血性卒中为首发症状的TA患者，较其他症状发病的患者，卒中年龄早10岁左右，BMI较低，高血压和非特异性系统症状发生率低，关节炎/关节痛、血压不对称和偏瘫发生率高，ITAS-2010较高。

文章导读： 缺血性卒中为首发症状的TA患者，在青年卒中群体中不易识别，本研究分析15例该类患者的临床特征，发现与以其他症状发病的TA合并卒中患者比较，首次卒中年龄更低，高血压发生率较低，但疾病活动性更高。

关键词: 大动脉炎; 缺血性卒中; 首发症状; 高血压; 印度大动脉炎临床活动度评分2010

Abstract: Objective To summarize the clinical characteristics of patients with ischemic stroke as the first presentation in Takayasu arteritis (TA). Methods The clinical data of patients with TA and ischemic stroke in Xuanwu Hospital from January 2010 to August 2021 were retrospectively analyzed. Based on whether the first symptom was ischemic stroke, the included patients were divided into ischemic stroke onset group and other symptoms onset group. The clinical characteristics between the two groups were compared. Results A total of 59 patients were included, with the mean age of 29.7±13.1 years (range: 8-51 years) and 7 males (11.9%). The mean age of first stroke onset was 35.8±14.1 years. There were 15 (25.4%) patients with ischemic stroke as the first symptom in stroke onset group, and the mean age of first stroke was lower than that of other symptoms onset group (27.2±9.6 years vs. 38.8±14.2 years, P =0.005). Compared with the other symptoms onset group, ischemic stroke onset group had lower body mass index (21.4±3.9 kg/m2 vs. 24.2±4.6 kg/m2, P =0.039), lower proportion of hypertension (6.7% vs. 34.1%, P =0.048), lower incidence of nonspecific symptoms (0 vs. 27.3%,

P =0.026), higher percentage of arthritis/arthralgia (20.0% vs. 2.3%, P =0.047), higher incidence of

blood pressure asymmetry (73.3% vs. 36.4%, P =0.018), higher incidence of hemiplegia (93.3% vs. 59.1%, P =0.023), and the higher ITAS-2010 score (12.2±5.4 vs. 7.1±5.8, P =0.004). Conclusions For TA patients with stroke as the first presentation, the age of stroke onset was about 10 years earlier, BMI and the incidences of hypertension and nonspecific symptoms were lower, the incidences of arthritis/arthralgia, blood pressure asymmetry and hemiplegia were higher, and the ITAS-2010 score was higher, compared to patients with other symptoms as the first presentation.

Key words: Takayasu arteritis; Stroke; First presentation; Hypertension; Indian Takayasu clinical activity score 2010

孔芳, 黄旭, 魏廉, 赵义. 以缺血性卒中发病的大动脉炎15例临床特点分析[J]. 中国卒中杂志, 2021, 16(12): 1210-1216.

KONG Fang, HUANG Xu, WEI Lian, ZHAO Yi. Clinical Characteristics of Case Series of Takayasu Arteritis with Ischemic Stroke as the First Sympotom[J]. Chinese Journal of Stroke, 2021, 16(12): 1210-1216.

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