arteritis

动脉炎
  • 文章类型: Journal Article
    背景:心脏可能与免疫球蛋白(Ig)-G4相关疾病(IgG4-RD)有关。本研究旨在总结IgG4-RD合并心脏受累患者的临床特点及治疗效果。
    方法:我们进行了一项回顾性研究,从北京协和医院和北京安贞医院的IgG4-RD队列中纳入了42例IgG4-RD患者,从2010年到2022年。临床,实验室,收集放射学数据,并分析了对糖皮质激素和免疫抑制剂的治疗反应。
    结果:与IgG4相关的心脏受累是IgG4-RD谱的罕见部分。冠状动脉周围炎和心包炎的发生率分别为1.2%(13/1075)和3.1%(33/1075),分别在我们的队列中。在两名患者中检测到可能与IgG4-RD相关的瓣膜疾病。没有发现心肌受累的患者。平均年龄58.2±12.8岁,男性占主导地位(76.7%)。冠状动脉CT显示,肿块样和弥漫性壁增厚病变是最常见的冠状动脉周炎类型。心包炎表现为心包积液,局部增厚,钙化和肿块。糖皮质激素和免疫抑制剂治疗后,所有患者的IgG4-RD反应者指数评分均降低,并获得放射学缓解.在维持期间,两名冠状动脉周炎患者经历了临床复发。
    结论:由于许多患者无症状,IgG4-RD的心脏受累很少且容易被忽视,诊断依赖于成像。患者对基于糖皮质激素的治疗表现出令人满意的反应。
    BACKGROUND: The heart can be involved in immunoglobulin (Ig)-G4-related disease (IgG4-RD). This study aimed to summarize the clinical features and efficacy of treatment for IgG4-RD patients with heart involvement.
    METHODS: We conducted a retrospective study enrolling 42 IgG4-RD patients with heart involvement from the IgG4-RD cohorts of the Peking Union Medical College Hospital and Beijing An Zhen Hospital, from 2010 to 2022. Clinical, laboratory, radiological data were collected, and treatment responses to glucocorticoids and immunosuppressants were analyzed.
    RESULTS: IgG4-related cardiac involvement is a rare part of the IgG4-RD spectrum. The incidences of coronary periarteritis and pericarditis were 1.2%(13/1075) and 3.1%(33/1075), respectively in our cohort. Valvular disease possibly related to IgG4-RD was detected in two patients. None of the patients with myocardial involvement were identified. The average age was 58.2 ± 12.8 years, with a male predominance (76.7%). Coronary artery CT revealed that mass-like and diffuse wall-thickening lesions were the most frequently observed type of coronary periarteritis. Pericarditis presented as pericardial effusion, localized thickening, calcification and mass. After treatment with glucocorticoid and immunosuppressants, all patients achieved a reduced IgG4-RD responder index score and achieved radiological remission. Two patients with coronary peri-arteritis experienced clinical relapses during the maintenance period.
    CONCLUSIONS: Cardiac involvement in IgG4-RD is rare and easily overlooked since many patients are asymptomatic, and the diagnosis relies on imaging. Patients showed a satisfactory response to glucocorticoid based treatment.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:传统上,使用6个月疗程的泼尼松龙治疗类固醇反应性脑膜炎-动脉炎(SRMA),但这种药物与副作用有关,可能导致生活质量差。
    目的:在6个月泼尼松龙方案和6周方案之间,SRMA的临床体征和复发率没有显著差异。
    方法:来自英国多个转诊中心的44例医院病例(2015-2019年)。44人中有20人采用6个月方案治疗,24/44人采用6周方案治疗。
    方法:前瞻性,12个月随访的随机试验。相同的泼尼松龙方案在复发的情况下重新开始。用二元Logistic和泊松回归模型分析复发。
    结果:所有病例均对其治疗方案有反应。复发发生在6个月方案的6/20(30%)和6周方案的9/24(38%)。两组之间至少1次复发的发生率风险没有统计学差异(比值比=1.40;95%置信区间[CI],0.40-4.96,P=0.60)。在15只复发的狗中,10/15(67%)复发一次,3/15(20%)复发两次,2/15(13%)复发3次。两组总复发事件发生率比(IRR)比较差异无统计学意义(IRR=1.46;95%CI,0.61~3.48;P=0.40)。
    结论:“短”6周泼尼松龙方案可用于治疗SRMA,从而可能减少泼尼松龙不良反应的持续时间和严重程度。
    BACKGROUND: Traditionally, 6-month courses of prednisolone are used to treat steroid-responsive meningitis-arteritis (SRMA), but this medication is associated with adverse effects that can lead to poor quality of life.
    OBJECTIVE: Resolution of clinical signs and rate of relapse of SRMA would not be significantly different between a 6-month prednisolone protocol and a 6-week protocol.
    METHODS: Forty-four hospital cases from multiple referral centers in the United Kingdom (2015-2019). Twenty of 44 were treated with the 6-month protocol and 24/44 with the 6-week protocol.
    METHODS: Prospective, randomized trial with 12-month follow-up. The same prednisolone protocol reinitiated in the event of relapse. Analysis of relapses with binary logistic and Poisson regression modeling.
    RESULTS: All cases responded to their treatment protocol. Relapses occurred in 6/20 (30%) of the 6-month protocol and 9/24 (38%) of the 6-week protocol. There was no statistical difference in the incidence risk of at least 1 relapse between the 2 groups (odds ratio = 1.40; 95% confidence interval [CI], 0.40-4.96, P = 0.60). Among the 15 dogs that relapsed, 10/15 (67%) relapsed once, 3/15 (20%) relapsed twice, and 2/15 (13%) relapsed 3 times. No statistical difference was detected in the incidence rate ratio (IRR) of total relapse events between the 2 groups (IRR = 1.46; 95% CI, 0.61-3.48; P = 0.40).
    CONCLUSIONS: \"Short\" 6-week prednisolone protocols could be used to treat SRMA, thereby presumably reducing the duration and severity of prednisolone\'s adverse effects.
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    文章类型: Journal Article
    UNASSIGNED: Strongylus vulgaris is one of the most pathogenic nematodes affecting equids. Larval migration through the cranial mesenteric artery (CMA) with attendant arteritis and thromboembolism can result in fatal non-strangulating intestinal infarction. Once considered a historical disease, recent studies have described the reemergence of this pathogen in several European countries; however, little is known of the current prevalence of S. vulgaris in the Canadian horse population.
    UNASSIGNED: To determine the prevalence of active S. vulgaris cranial mesenteric arteritis in horses submitted for postmortem examination to the Diagnostic Services Unit (DSU) at the University of Calgary Faculty of Veterinary Medicine.
    UNASSIGNED: We conducted a retrospective review of all equine postmortem cases submitted to the DSU between July 1, 2010 and June 30, 2022. Over 12 y, 510 horses > 2 mo of age from Alberta were submitted to the DSU for necropsy. Active cases were defined as those with endarteritis and thrombosis in the CMA or its branches. Those cases with only intimal scarring of the CMA were classified as historical.
    UNASSIGNED: The prevalence of all CMA lesions (both historical and active) over the study period was 17.3% (88/510). Active S. vulgaris cranial mesenteric arteritis was documented in 6.1% (31/510) of equine postmortems and the sequelae of verminous arteritis were the cause of euthanasia or death in 1.5% (8/510) of the cases submitted.
    UNASSIGNED: Even after historically intense efforts to eradicate this parasite, the continued effects of S. vulgaris are demonstrated by the results of this study. Strongylus vulgaris should not be regarded as a parasite of the past and verminous arteritis remains an important differential diagnosis for horses in western Canada presenting with mild colic or dull demeanor and anorexia of duration > 24 h. Furthermore, S. vulgaris should be taken into careful consideration when implementing antiparasitic control strategies. Practitioners should remain current on prevention, diagnosis, and treatment of this potentially reemerging and fatal equine disease.
    Étude rétrospective de la prévalence lors d’autopsies équines de l’artérite mésentérique crâniale causée par Strongylus vulgaris en Alberta (2010 à 2022).
    UNASSIGNED: Strongylus vulgaris est l’un des nématodes les plus pathogènes affectant les équidés. La migration des larves à travers l’artère mésentérique crâniale (CMA), accompagnée d’artérite et de thromboembolie, peut entraîner un infarctus intestinal non étranglant mortel. Autrefois considérée comme une maladie historique, des études récentes ont décrit la réémergence de cet agent pathogène dans plusieurs pays européens; cependant, on sait peu de choses sur la prévalence actuelle de S. vulgaris dans la population équine canadienne.
    UNASSIGNED: Déterminer la prévalence de l’artérite mésentérique crâniale active à S. vulgaris chez les chevaux soumis pour examen post mortem au Diagnostic Service Unit (DSU), College of Veterinary Medicine, University of Calgary.
    UNASSIGNED: Nous avons effectué un examen rétrospectif de tous les cas post-mortem d’équidés soumis au DSU entre le 1er juillet 2010 et le 30 juin 2022. Sur 12 ans, 510 chevaux âgés de plus de 2 mois de l’Alberta ont été soumis au DSU pour autopsie. Les cas actifs ont été définis comme ceux présentant une endartérite et une thrombose dans la CMA ou ses branches. Les cas présentant uniquement des cicatrices à l’intima de la CMA ont été classés comme anciens.
    UNASSIGNED: La prévalence de toutes les lésions de CMA (anciennes et actives) au cours de la période d’étude était de 17,3 % (88/510). Une artérite mésentérique crâniale active à S. vulgaris a été documentée dans 6,1 % (31/510) des autopsies équines et les séquelles de l’artérite vermineuse ont été la cause de l’euthanasie ou du décès dans 1,5 % (8/510) des cas soumis.
    UNASSIGNED: Malgré des efforts historiquement intenses pour éradiquer ce parasite, les effets continus de S. vulgaris sont démontrés par les résultats de cette étude. Strongylus vulgaris ne doit pas être considéré comme un parasite du passé et l’artérite vermineuse demeure un diagnostic différentiel important pour les chevaux de l’ouest du Canada présentant des coliques légères ou un comportement abattu et une anorexie de durée > 24 h. De plus, S. vulgaris doit être attentivement pris en compte lors de la mise en œuvre de stratégies de contrôle antiparasitaire. Les praticiens doivent rester informés de la prévention, du diagnostic et du traitement de cette maladie équine potentiellement ré-émergente et mortelle.(Traduit par Dr Serge Messier).
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  • 文章类型: Journal Article
    免疫介导的血管病变继发于感染或其他非感染性刺激。潜在的触发因素包括异源抗原,包括病毒,注射的蛋白质和药物;或自身抗原,包括免疫球蛋白或其他内源性蛋白质。虽然这些情况在马匹中很少见,免疫介导的血管病变可以引起相当大的发病率,根据严重程度和受影响的器官系统,有不同的临床体征。例子包括出血性紫癜,系统性红斑狼疮,药物性血管炎,副肿瘤性血管炎,和特发性免疫介导性血管炎。如果存在皮肤体征,诊断是推定的或基于皮肤活检的组织病理学。治疗依赖于消除煽动原因,免疫抑制,和支持性护理。
    Immune-mediated vasculopathies occur secondary to infection or another noninfectious stimulus. Potential triggers include heterologous antigens including viruses, injected proteins and drugs; or auto-antigens including immunoglobulins or other endogenous proteins. Although these conditions are rare in horses, immune-mediated vasculopathies can cause considerable morbidity, with variable clinical signs depending on severity and organ system affected. Examples include purpura hemorrhagica, systemic lupus erythematosus, drug-induced vasculitis, paraneoplastic vasculitis, and idiopathic immune-mediated vasculitis. Diagnosis is presumptive or based on histopathology of skin biopsies if cutaneous signs are present. Treatment relies on removing the inciting cause, immunosuppression, and supportive care.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    Scedosporiumspp.和长龙孢菌是新兴的非曲霉丝状真菌。我们以前进行的Scedosporiosis/lomentosporiosis观察性研究报告了频繁的真菌血管受累,包括主动脉炎和外周动脉炎。对于这篇文章,我们回顾了7例Scedosporiumspp。和产乳杆菌性动脉炎来自头孢孢子菌病/lomentosporiosis观察研究和13例来自已发表文献。据报道,70%(14/20)的病例患者存在潜在的免疫抑制,主要是那些有实体器官移植(10/14)。在50%(10/20)的病例中观察到骨关节感染的定位;感染经常(7/10)与血管感染部位相邻。Scedosporiumspp./20例患者中有9例在完成非血管性scedosporiosis/lomentosporiosis治疗后3个月内被诊断出感染。在8/11主动脉炎和6/10周围动脉炎病例中发现动脉瘤。侵袭性真菌疾病相关死亡人数较高(12/18[67%])。头孢孢子菌属的血管嗜性。产乳杆菌显示血管成像,比如计算机断层扫描血管造影,需要管理感染,特别是对于骨关节位置。
    Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.
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  • 文章类型: Journal Article
    溶胆链球菌亚种巴氏菌是牛链球菌的一种亚型(S.bovis)已越来越被认为是新生儿中引起败血症的病原体。有据可查的是,牛链球菌对心脏和胃肠道组织都有偏爱,在成年人群中,在血液中分离这些生物通常会触发对结肠癌或心内膜炎等合并症的进一步评估.然而,目前在新生儿文献中没有这样的指导。我们介绍了一例患有胆溶链球菌亚种的早产儿。巴氏菌血症表现为坏死性小肠结肠炎(NEC),以前未在文献中描述。此外,通过完整的诊断评估,包括超声心动图,我们的病人被发现有心内膜炎的罕见并发症。
     Streptococcus gallolyticus subspecies pasteurianus is a subtype of Streptococcus bovis (S. bovis) that has become increasingly recognized as a sepsis-causing pathogen in neonates. It is well documented that S. bovis species have a predilection to both cardiac and gastrointestinal tissue, and in adult populations, isolating these organisms in the bloodstream often triggers further evaluation for co-morbid complications such as colon cancer or endocarditis. However, no such guidance currently exists in neonatal literature. We present a case of a preterm infant with S. gallolyticus subsp. pasteurianus bacteremia presenting as necrotizing enterocolitis (NEC) not previously described in the literature. Furthermore, through a complete diagnostic evaluation, including an echocardiogram, our patient was found to have the rare complication of endocarditis.
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