case control study

病例对照研究
  • 文章类型: English Abstract
    Nutritional exposure is considered the main environmental influence that contributes to gallstone disease (GD).
    The aim of this study was to determine food intakes patters and estimate risk of GD.
    A nested case-control study was carried out within the framework of a previous screening study conducted on a representative sample in Rosario, Argentina. Participants underwent a personal interview. Average amount of each food intake and quantity nutrients were estimated applying a food-frequency questionnaire. Food consumption patterns were identified by principal component analysis, and logistic regression analysis was used to estimate risks.
    The sample was conformed by 51 cases and 69 controls. Two dietary patterns were identified. Cases were characterised by the unhealthy intake pattern (high intakes of animal fats, sugar, cereals, grains, cold cuts, processed meats, chicken with skin, fat beef and low intake of red vegetables and yellows, cabbages, fruits and fish).
    Controls were characterised by the healthy intake pattern (high intake of skinless chicken, nuts, lean beef, vitamin A and C rich fruits, and low consumption of chicken with skin, green leaves vegetables and sprouts). The unhealthy pattern showed an increased risk of developing GD while healthy patter behaved as a protective factor.
    La exposición nutricional se considera la principal exposición ambiental que contribuye a la formación de cálculos biliares.
    El objetivo de este trabajo fue determinar el patrón de consumo alimentario de casos y controles de EC y estimar el riesgo de desarrollar la enfermedad según los distintos patrones constituidos.
    Se llevó a cabo un estudio analítico retrospectivo transversal de casos y controles, anidado a un estudio de prevalencia realizado en Rosario. Todos los participantes fueron entrevistados personalmente. El consumo de alimentos se consignó a través de un cuestionario semi-cuantitativo de frecuencia de consumo. Para determinar patrones de consumo alimentario se realizó un análisis de componentes principales, y análisis de regresión logística múltiple para evaluar riesgos.
    La muestra quedó conformada por 51 casos y 69 controles. Se determinaron dos componentes que permitían diferenciar los casos de los controles, a través de las cuales se establecieron 2 patrones de consumo. Los casos se caracterizaron por un consumo determinado por el Patrón Poco saludable (altas ingestas de grasas animales, azúcar, cereales, granos, fiambres y embutidos) y los controles por el consumo del patrón Saludable (altas ingestas de pollo sin piel, frutas secas, carne vacuna magra, frutas, lácteos enteros). El patrón Poco saludable, aumentó el riesgo de desarrollar EC mientras que el patrón Saludable, se comportó como protector.
    Los patrones constituidos diferencian los casos de los controles, y la ingesta propia de los casos se correlaciona con un perfil de consumo que caracteriza a las culturas occidentales modernas y urbanas.
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  • 文章类型: Journal Article
    神经管缺陷(NTDs)是由于神经管在26至28天的胚胎年龄不完全闭合而发生的。解决与NTD相关的因素将有助于识别和优先考虑高风险女性,这反过来又指导了预防策略。该研究旨在确定在阿达玛医院医学院分娩或妊娠中期流产的妇女中与NTD相关的因素,从1月1日到12月31日,2019.
    对344名妇女进行了基于医院的无匹配病例对照研究。数据采用SPSS20进行分析。计算了描述性统计数据。进行二元逻辑回归分析以确定与NTDs相关的因素。
    在没有婚姻关系的女性中,胎儿患有NTDs的几率高出2.19倍(AOR=2.19;95%CI:1.13,4.25)。既往有流产史或死产史的女性患NTDs的风险增加3倍(AOR=3.05;95%CI:1.58,5.88)。住房条件不足几乎使胎儿患有NTDs的几率加倍(AOR=1.91;95%CI:1.20,3.04)。妊娠早期补充叶酸或多种维生素可使胎儿患NTDs的几率降低43%(AOR=0.57;95%CI:0.35,0.91)。
    没有婚姻关系,既往有流产或死胎史,居住条件不足是NTD的危险因素,而补充多种维生素或叶酸是保护因素。
    UNASSIGNED: Neural tube defects (NTDs) occur as a result of incomplete closure of the neural tube by the embryonic age of 26 to 28 days. Addressing factors associated with NTDs would help to identify and prioritize high-risk women, which in turn guides the preventive strategy. The study aimed to identify factors associated with NTDs among women who gave birth or had a second-trimester abortion at Adama Hospital Medical College, from January 1st to December 31st, 2019.
    UNASSIGNED: Hospital based unmatched case-control study was conducted on 344 women. Data were analyzed with SPSS 20. Descriptive statistics were computed. Binary logistic regression analysis was performed to determine factors associations with NTDs.
    UNASSIGNED: The odds of having a fetus with NTDs were 2.19 times higher among women who are not in a marital relationship (AOR = 2.19; 95% CI: 1.13, 4.25). Women with a previous history of Abortion or stillbirth had 3 fold increased risk of having a fetus with NTDs (AOR = 3.05; 95% CI: 1.58, 5.88). Inadequate housing condition nearly doubles the odds of having a fetus with NTDs (AOR = 1.91; 95% CI: 1.20, 3.04). Folic acid or multivitamin supplementation early in pregnancy reduced the odds of having a fetus with NTDs by 43% (AOR = 0.57; 95% CI: 0.35, 0.91).
    UNASSIGNED: Being not in a marital relationship, previous history of abortion or stillbirth, and living in inadequate housing conditions were risk factors for NTDs, while multivitamins or folic acid supplementation was a protective factor.
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  • 文章类型: Journal Article
    在感染弓形虫的个体中很少报道腹痛(T。gondii)。这项研究的目的是确定弓形虫感染与腹痛之间的关系。对二百九十九名腹痛患者(病例)和299名年龄和性别匹配的无腹痛患者(对照)进行了抗T。弓形虫IgG和IgM抗体。299例病例中有24例(8.0%)和299例对照中有12例(4.0%)抗T。gondiiIgG抗体(OR:2.08;95%CI:1.02-4.25;P=0.03)。经常腹痛的女性弓形虫感染的血清阳性率明显高于没有这种临床特征的女性(OR:2.30;95%CI:1.06-4.96;P=0.02)。299例病例中有12例(4.0%)和299例对照中有7例(2.3%)具有高(>150IUmL-1)抗T。gondiiIgG抗体水平(OR:1.74;95%CI:0.67-4.49;P=0.24)。24例抗T.刚地IgG抗体和3(25.0%)的12个对照与抗T。gondiiIgG抗体对抗T.gondiiIgM抗体(OR:1.23;95%CI:0.25-5.97;P=1.00)。结果表明弓形虫感染与频繁腹痛之间存在关联。应该进行进一步的研究以确认这种关联。
    Abdominal pain has been rarely reported in individuals infected with Toxoplasma gondii (T. gondii). The aim of this study was to determine the association between T. gondii infection and abdominal pain. Two hundred and ninety-nine patients with abdominal pain (cases) and 299 age- and gender-matched people without abdominal pain (controls) were tested for anti-T. gondii IgG and IgM antibodies. Twenty-four (8.0%) of the 299 cases and 12 (4.0%) of the 299 controls were positive for anti-T. gondii IgG antibodies (OR: 2.08; 95% CI: 1.02-4.25; P = 0.03). The seroprevalence of T. gondii infection was significantly higher in women with frequent abdominal pain than in women without this clinical feature (OR: 2.30; 95% CI: 1.06-4.96; P = 0.02). Twelve (4.0%) of the 299 cases and 7 (2.3%) of the 299 controls had high (>150 IU mL-1) anti-T. gondii IgG antibody levels (OR: 1.74; 95% CI: 0.67-4.49; P = 0.24). Seven (29.2%) of the 24 cases with anti-T. gondii IgG antibodies and 3 (25.0%) of the 12 controls with anti-T. gondii IgG antibodies were positive to anti-T. gondii IgM antibodies (OR: 1.23; 95% CI: 0.25-5.97; P = 1.00). Results suggest an association between T. gondii infection and frequent abdominal pain. Further research to confirm this association should be conducted.
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  • 文章类型: Journal Article
    背景:自闭症谱系障碍(ASD)是遗传性神经发育障碍(NDD),但是环境风险因素也被认为在其发展中起作用。产前,围产期和父母因素与儿童ASD风险增加相关.本研究的目的是探索产前,围产期,北京自闭症谱系障碍(ASD)儿童的育儿危险因素,中国通过将它们与典型的发育(TD)儿童进行比较。
    方法:本研究以北京康复机构的151名ASD儿童父母为样本,另外招募来自北京幼儿园的151名儿童作为对照组(儿童年龄:平均=4.4岁)。TD儿童根据年龄匹配,性和母亲教育。我们探索了母体AQ(自闭症谱系商)评分(平均值:19.40-19.71,两组之间无显着差异)以参考遗传基线。本研究通过未调整和调整分析评估了17个因素。
    结果:出生窒息与ASD的风险高出13倍以上相关(校正比值比(AOR)=13.42)。母乳喂养困难与ASD的高风险相关(AOR=3.46)。育儿会影响ASD的风险,低反应(LR)和苛刻或忽视的育儿与后代ASD的高风险相关(LR的AOR=2.37,严厉的育儿AOR=3.42,忽视的育儿AOR=3.01)。孕妇在怀孕期间发烧与后代发生ASD的风险更高(AOR=3.81)。
    结论:许多因素与后代ASD相关。需要进一步评估以阐明可改变的环境因素在预防战略中的作用。
    BACKGROUND: Autism spectrum disorder (ASD) is heritable neurodevelopmental disorders (NDDs), but environmental risk factors have also been suggested to a play a role in its development. Prenatal, perinatal and parental factors have been associated with an increased risk of ASD in children. The aim of the present study was to explore the prenatal, perinatal, and parenting risk factors in children with autism spectrum disorder (ASD) from Beijing, China by comparing them with typically developing (TD) children.
    METHODS: A sample of 151 ASD children\'s parents who from rehabilitation institutions in Beijing were enrolled in this study, and an additional 151 children from kindergartens in Beijing were recruited as a control group (child age: mean = 4.4 years). TD children were matched according to age, sex and maternal education. We explored the maternal AQ (Autism Spectrum Quotient) scores (mean:19.40-19.71, no significant difference between two groups) to referring the genetic baseline. This study evaluated 17 factors with unadjusted and adjusted analyses.
    RESULTS: Birth asphyxia was associated with a more than a thirteen-fold higher risk of ASD (adjusted odds ratio (AOR) = 13.42). Breastfeeding difficulties were associated with a higher risk of ASD(AOR = 3.46). Parenting influenced the risk of ASD, with low responding (LR) and harsh or neglectful parenting associated with a higher risk of ASD in offspring (AOR = 2.37 for LR, AOR = 3.42 for harsh parenting and AOR = 3.01 for neglectful parenting). Maternal fever during pregnancy was associated with a higher risk of ASD in offspring (AOR = 3.81).
    CONCLUSIONS: Many factors were associated with ASD in offspring. Further assessment is needed to elucidate the role of modifiable environmental factors to inform prevention strategies.
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  • 文章类型: Journal Article
    宫颈癌是肯尼亚女性癌症死亡的主要原因。肯尼亚三分之二的宫颈癌病例被诊断为晚期。我们旨在确定与宫颈癌晚期诊断相关的因素,指导政策干预。
    在Kenyatta国立和Moi教学和转诊医院对年龄≥18岁的宫颈癌女性进行了一项不匹配的病例对照研究(比例为1:2)。我们将一个病例定义为国际妇产科联合会(FIGO)分期≥2A的患者,而对照为分期≤1B的患者。使用结构化问卷记录暴露变量。我们计算了调整后的比值比(aOR)以确定任何关联。
    我们登记了192名参与者(64例,128个控件)。平均年龄39.2(±9.3)岁,145(76%)已婚,77人(40%)接受过初等教育,168人(88%)第一次怀孕≤24岁,85(44%)>第3段和150(78%)使用避孕药具。宫颈癌的晚期诊断与前往癌症中心的旅行费用>6.1美元相关(aOR6.4395%CI[1.30,31.72]),年龄>50岁(aOR4.71;95%CI[1.18,18.80]),对癌症治疗费用的焦虑(aOR5.6;95%CI[1.05,32.72])和症状评估期间的超声检查(aOR4.89;95%CI[1.07-22.42])。先前对妇科感染的治疗(aOR0.10;95%CI[0.02,0.47])对晚期诊断具有保护性。
    寻求护理的成本和诊断过程的质量是本研究的重要因素。护理权力下放,在肯尼亚,创新的健康融资解决方案以及针对出现妇科症状的女性的明确诊断和转诊算法可以减少晚期诊断.
    UNASSIGNED: Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions.
    UNASSIGNED: An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations.
    UNASSIGNED: We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis.
    UNASSIGNED: Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.
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  • 文章类型: Journal Article
    目的:中国医生开发了胫骨横向运输(TTT)技术来治疗糖尿病足溃疡,有效率超过90%。但这种方法仍然无法避免患者的院内死亡。本研究采用病例对照研究,探讨老年慢性缺血性糖尿病足患者接受TTT治疗后院内死亡的危险因素。
    方法:从2017年1月1日至2021年4月30日,共纳入54例患者,与病例组患者的人口统计学资料和血常规结果配对,肝肾功能。病例组9例,男6例,男3例。根据性别和糖尿病类型选择45例患者作为对照组,其中男30例,女15例。采用单因素Logistic回归分析探讨住院患者死亡的危险因素及奇数比(OR)。通过RStudio软件进行了列线图和决策曲线分析(DCA)。
    结果:研究发现,年龄,糖尿病足的病程,低密度脂蛋白(smLDL),同型半胱氨酸(Hcy),超氧化物歧化酶(SOD),和前白蛋白(PA)是患者院内死亡的危险因素。smLDL的风险最高。列线图显示,PA在死亡危险因素中所占比例最大。DCA结果证明以上6个危险因素是TEXAS3期和4期糖尿病足溃疡患者的危险因素。
    结论:在未来糖尿病足溃疡的诊断和TTT治疗中,医生需要密切关注年龄,糖尿病足的病程,smLDL,Hcy,SOD,和PA。
    OBJECTIVE: Chinese physicians developed the Tibial Transverse Transport (TTT) technique to treat diabetic foot ulcers with more than 90% effective rate. But this method still could not avoid the in-hospital death of patients. This study adopted a case-control study to explore the risk factors of in-hospital death in elderly patients with chronic ischemic diabetic foot after receiving TTT treatment.
    METHODS: A total of 54 patients were included in the study from January 1, 2017 to April 30, 2021, by being paired with the cases in case group with their demographic data and results of blood routine, liver and kidney function. There were nine patients in case group with six male and three male. Forty-five patients were selected in control group according to gender and diabetes type with 30 male and 15 female. Single factor logics regression analysis was used to explore the risk factors and odd ratios (OR) of in-hospital death in patients. The nomogram and decision curve analysis (DCA) had been done by R Studio software.
    RESULTS: The study found that age, course of diabetic foot, small dense low-density Lipoprotein (smLDL), homocysteine (Hcy), superoxide dismutase (SOD), and prealbumin (PA) were risk factors for in-hospital death of patients. The smLDL had the highest risk. The nomogram showed that PA accounted for the largest proportion in the death risk factors. The results of DCA proved that above six risk factors were the risk factors for patients with TEXAS Stage 3 and 4 diabetic foot ulcers.
    CONCLUSIONS: In the future diagnosis and TTT treatment for diabetic foot ulcers, doctors need to pay close attention to age, course of diabetic foot, smLDL, Hcy, SOD, and PA.
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  • 文章类型: Journal Article
    一定数量的重症肌无力(MG)患者在MG发病前临床上患有2型糖尿病(T2DM),提示MG的发病可能与T2DM病史有关。本研究旨在探讨MG与T2DM的相关性。
    在单中心,回顾性,1:5匹配的病例对照研究,纳入2014年8月8日至2019年1月22日诊断为MG的所有118例住院患者.总的来说,从电子病历(EMR)中检索了4个不同来源的对照组数据集.在个体水平上收集数据。使用条件logistic回归分析来检验MG与T2DM相关的风险。
    MG的风险与T2DM显著相关,性别和年龄差异显著。无论是与普通人群相比,一般无自身免疫性疾病(AIDs)的住院患者,或除MG以外的其他AIDs患者,50岁以上的T2DM女性患MG的风险增加.糖尿病MG患者的平均发病年龄大于非糖尿病MG患者。
    这项研究表明,T2DM与MG的后续风险密切相关,并且因性别和年龄而异。它揭示了糖尿病MG可能是不同于常规MG亚组分类的独特亚型。糖尿病MG患者的临床和免疫学特征有待进一步研究。
    UNASSIGNED: A certain number of myasthenia gravis (MG) patients clinically had type 2 diabetes mellitus (T2DM) prior to MG onset, which suggests that the onset of MG may correlate with the history of T2DM. This study aimed to examine the correlation between MG and T2DM.
    UNASSIGNED: In a single-center, retrospective, 1:5 matched case-control study, all 118 hospitalized patients with a diagnosis of MG from 8 August 2014 to 22 January 2019 were enrolled. In total, four datasets with different sources of the control group were retrieved from the electronic medical records (EMRs). Data were collected at the individual level. A conditional logistic regression analysis was used to test the risk of MG associated with T2DM.
    UNASSIGNED: The risk of MG was significantly associated with T2DM, and there were notable differences by sex and age. Whether compared to the general population, general hospitalized patients without autoimmune diseases (AIDs), or patients with other AIDs except MG, women aged over 50 years with T2DM had an increased risk of MG. The mean onset age of diabetic MG patients was more than that of the non-diabetic MG patients.
    UNASSIGNED: This study demonstrates that T2DM is strongly associated with the subsequent risk of MG and varies significantly by sex and age. It reveals that diabetic MG may be a unique subtype that is different from the conventional MG subgroup classification. More clinical and immunological features of diabetic MG patients need to be explored in further studies.
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  • 文章类型: Journal Article
    背景:调查德国三级医院外科病房和相关重症监护病房住院患者中存在耐万古霉素肠球菌(VRE)的危险因素。
    方法:对2013年7月至2016年12月收治的外科住院患者进行了单中心回顾性配对病例对照研究。纳入入院后48小时后在院内检测到VRE的患者,包括116例VRE阳性病例和116例VRE阴性匹配对照。病例VRE分离株采用多位点序列分型。
    结果:ST117被鉴定为优势VRE序列类型。除了在医院或重症监护病房和先前透析的住院时间外,病例对照研究还显示,先前的抗生素治疗是院内检测VRE的危险因素。抗生素哌拉西林/他唑巴坦,美罗培南,万古霉素与最高风险相关。考虑到住院时间可能会混淆其他潜在的接触相关风险因素,例如以前的超声检查,放射学,中心静脉导管,和内窥镜检查没有显著性。
    结论:既往透析和既往抗生素治疗被认为是手术住院患者VRE存在的独立危险因素。
    BACKGROUND: Investigation of risk factors for the presence of vancomycin-resistant enterococci (VRE) in inpatients on surgical wards and associated intensive care units of a German tertiary care hospital.
    METHODS: A single-centre retrospective matched case-control study was performed with surgical inpatients admitted between July 2013 and December 2016. Patients with in-hospital detection of VRE later than 48 h after admission were included and comprised 116 VRE-positive cases and 116 VRE-negative matched controls. VRE isolates of cases were typed by multi-locus sequence typing.
    RESULTS: ST117 was identified as the dominant VRE sequence type. Next to length of stay in hospital or on an intensive care unit and previous dialysis the case-control study revealed previous antibiotic therapy as a risk factor for the in-hospital detection of VRE. The antibiotics piperacillin/tazobactam, meropenem, and vancomycin were associated with the highest risks. After taking into account length of stay in hospital as possible confounder other potential contact-related risk factors such as previous sonography, radiology, central venous catheter, and endoscopy were not significant.
    CONCLUSIONS: Previous dialysis and previous antibiotic therapy were identified as independent risk factors for the presence of VRE in surgical inpatients.
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  • 文章类型: Journal Article
    背景:各种炎性疾病与各种疫苗的施用有关。一些报道已经将疫苗施用与中枢神经系统(CNS)的脱髓鞘疾病相关联。然而,目前尚无明确或有力的科学证据支持疫苗给药与脱髓鞘疾病的发病相关.一些中枢神经系统脱髓鞘疾病,如急性播散性脑脊髓炎(ADEM)和视神经脊髓炎谱系障碍(NMOSD),在服用COVID-19疫苗后报告。在这项研究中,据报道,使用COVID-19疫苗后出现新发多发性硬化症(MS)。
    方法:在这项纵向观察性病例对照研究中,总共研究了65名参与者,他们被分成两组。A组包括32名确诊为COVID-19疫苗接种后的MS患者,B组包括33名接受COVID-19疫苗但未发展MS的参与者。B组用作对照。使用统计产品和服务解决方案(SPSS)(IBMSPSSStatisticsforWindows,Armonk,NY)软件。
    结果:进行了单因素和多因素logistic回归分析,确定了危险因素与COVID-19疫苗接种后MS发展之间的显着相关性。
    结论:危险因素,在这项研究中确定,可作为发展MS后COVID-19疫苗接种的重要独立预测因子。
    BACKGROUND: Various inflammatory diseases have been associated with the administration of various vaccines. Several reports have associated vaccine administration with the demyelinating diseases of the central nervous system (CNS). However, no clear or strong scientific evidence exists to support the association of vaccine administration with the onset of demyelinating diseases. Some CNS demyelination diseases such as acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD) were reported following the administration of COVID-19 vaccines. In this study, new onset multiple sclerosis (MS) following COVID-19 vaccine administration was reported.
    METHODS: In this longitudinal observational case-control study, a total of 65 participants were studied, who were divided into two groups. Group A included 32 MS patients who were diagnosed post-COVID-19 vaccine administration and group B included 33 participants who received COVID-19 vaccines and did not develop MS. Group B was used as a control. The Chi-square test and logistic regression analysis were carried out using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Armonk, NY) software.
    RESULTS: Univariate and multivariate logistic regression analysis was performed and a significant correlation between the risk factors and the development of MS post-COVID-19 vaccination was identified.
    CONCLUSIONS: The risk factors, identified in this study, can be used as significant independent predictors for developing MS post-COVID-19 vaccinations.
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  • 文章类型: Journal Article
    背景:经活检证实的巨细胞动脉炎(GCA)偶尔表现为无急性期反应。在此设置中,GCA最初可能被忽视,糖皮质激素治疗过度延迟,潜在增加缺血风险。
    方法:从新诊断患者的初始队列中,活检证实的GCA,我们检索了开始糖皮质激素治疗前红细胞沉降率(ESR)和C反应蛋白(CRP)水平未升高的所有病例.我们比较了这些患者和GCA诊断后招募的另外两名患者的基线特征和结果与42名随机选择的具有高基线ESR和CRP的患者的基线特征和结果。
    结果:在396名患者中,14(3.5%)的ESR和CRP基线值均较低。较低的基线ESR和CRP与较少的美国风湿病学会标准(p<0.001,95%CI-1.1;-0.9),和较少的颌骨跛行(p=0.06,95%CI0.8;44.9),但永久性失明的发生率相似(p=1.0)。ESR和CRP较低的患者在平均血细胞计数和平均血红蛋白水平方面也表现出明显的差异,但抗心磷脂抗体阳性(p=0.04,95%CI0.8;∞)和肝胆汁淤积(p=0.03,95%CI1.0;422)也较少。ESR和CRP较低的患者GCA复发较少(p=0.03,95%CI-1.1;-0.1),糖皮质激素诱导的并发症较少(p=0.01,95%CI-2.0;-0.1),和成功停止糖皮质激素比其他患者早(18.3个月比平均34个月,p=0.02,95%CI-27;-0.9)。
    结论:活检证实的GCA表现为较低的ESR和CRP并不例外。它在临床上不太典型,但与其他形式的疾病具有相似的缺血性风险。相反,这些患者的晚期GCA预后良好。
    Biopsy-proven giant cell arteritis (GCA) occasionally presents without acute-phase reaction. In this setting, GCA may be initially overlooked and glucocorticoid treatment unduly delayed, potentially increasing ischemic risk.
    From an inception cohort of patients with newly diagnosed, biopsy-verified GCA, we retrieved all cases without elevation of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level before starting glucocorticoid treatment. We compared the baseline features and outcomes of these patients and two additional patients recruited after GCA diagnosis with those of 42 randomly selected patients with high baseline ESR and CRP.
    Of 396 patients, 14 (3.5%) had lower baseline values of both ESR and CRP. Lower baseline ESR and CRP were associated with fewer American College of Rheumatology criteria met (p < 0.001, 95% CI - 1.1; - 0.9), and less jaw claudication (p = 0.06, 95% CI 0.8; 44.9), but similar rates of permanent blindness (p = 1.0). Patients with lower ESR and CRP also showed obvious differences regarding mean blood cell counts and mean hemoglobin level, but also less anti-cardiolipin antibody positivity (p = 0.04, 95% CI 0.8; ∞) and hepatic cholestasis (p = 0.03, 95% CI 1.0; 422). Patients with lower ESR and CRP had fewer GCA relapses (p = 0.03, 95% CI - 1.1; - 0.1), fewer glucocorticoid-induced complications (p = 0.01, 95% CI - 2.0; - 0.1), and successfully stopped glucocorticoids sooner than the other patients (18.3 months vs 34 months in average, p = 0.02, 95% CI - 27;- 0.9).
    Biopsy-proven GCA presenting with lower ESR and CRP is not an exceptional occurrence. It is clinically less typical but carries similar ischemic risk to other forms of the disease. Conversely, the late GCA prognosis of these patients is excellent.
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