METHODS: We conducted a non-interventional observational study of 30 consecutive patients hospitalized for suspected GCA, including a comprehensive analysis of clinical, laboratory, imaging, CDI and pathology data. GCA was diagnosed or excluded (GCA+, GCA-, respectively) according to American College of Rheumatology (ACR) criteria and TAB findings. Three patients not meeting ACR criteria were excluded secondarily. The GCA- group contained ten patients, and the GCA+ group contained 17 patients, including eight with unilateral, transient or permanent clinical visual impairment (CVI).
RESULTS: Mean blood flow velocity (mBFV) in the CRA was impaired in the affected eyes of GCA + CVI+ patients (1.9 ± 0.9 cm.s-1, p < 0.001) relative to controls (4.1 ± 1.0 cm.s-1), GCA- patients (3.6 ± 0.7 cm.s-1) and GCA + CVI- patients (3.8 ± 0.8 cm.s-1). The mBFVs of the CRA was similar for affected and fellow eyes (right or left). CRA mBFV measurements effectively differentiated between patients with and without CVI (ROC-curve analysis, AUC = 0.925 [95%CI: 0.700 to 0.996], p < 0.0001, 88% sensitivity, 89% specificity, and cutoff of ≤2.7 cm.s-1 for affected eyes; 75% sensitivity, 100% specificity and cutoff of ≤2.2 cm.s-1 for fellow eyes).
CONCLUSIONS: CDI facilities the early detection of visual ischemia risk in GCA+ patients, justifying urgent high-dose corticosteroid administration to save at least the fellow eye before pathology results become available.
方法:我们对30例因怀疑GCA而住院的连续患者进行了一项非干预性观察性研究,包括全面的临床分析,实验室,成像,CDI和病理资料。GCA被诊断或排除(GCA+,GCA-,分别)根据美国风湿病学会(ACR)标准和TAB发现。不符合ACR标准的三名患者被二次排除。GCA组包含10名患者,GCA+组包含17名患者,包括八个单方面的,短暂性或永久性临床视力障碍(CVI)。
结果:在GCACVI患者的受累眼中,CRA的平均血流速度(mBFV)受损(1.9±0.9cm。s-0.1,p<0.001)相对于对照组(4.1±1.0cm。s-1),GCA-患者(3.6±0.7cm。s-1)和GCA+CVI-患者(3.8±0.8cm。s-1).CRA的mBFV对于受影响的和同侧的眼睛(右或左)是相似的。CRAmBFV测量有效区分有和没有CVI的患者(ROC曲线分析,AUC=0.925[95CI:0.700至0.996],p<0.0001,88%灵敏度,89%的特异性,和≤2.7厘米的截止。s-1适用于受影响的眼睛;75%的敏感度,100%特异性和≤2.2cm的截止值。s-1代表同伴的眼睛)。
结论:CDI有助于GCA+患者视觉缺血风险的早期检测,在获得病理结果之前,证明紧急大剂量皮质类固醇给药是合理的,以挽救至少另一只眼睛。