■巨细胞动脉炎(GCA)是一种全身性肉芽肿性血管炎,累及中型和大型动脉,并且可能存在一系列的眼科发现。这篇综述将涵盖GCA流行病学,病理生理学,临床表现,诊断检查,和治疗。
■GCA常见于老年患者和斯堪的纳维亚血统的个体。最近的出版物表明,这种情况在非洲裔美国人和西班牙裔美国人中可能比以前认为的更普遍。这在亚洲和中东人群中非常罕见,关于非洲人口的数据很少。遗传研究已经确定与HLA-DRB1*04相关的风险增加。而不是对水痘带状疱疹病毒等特定抗原的反应,目前的免疫学研究表明,GCA的结果是与衰老免疫系统相关的变化。
■动脉炎性前部缺血性视神经病变是GCA最常见的眼科表现,但是视网膜中央或分支动脉阻塞,眼动脉闭塞,引起复视的颅神经病,更罕见的是,还可能发生前节缺血和不等。包括视野测试在内的临床测试,OCT,OCT-A,除临床检查外,ICG和荧光素血管造影术还有助于提示诊断。
■GCA最终是一种临床诊断,但它通常得到实验室结果的支持,病理学,和/或成像。颞动脉活检(TAB)仍然是诊断测试的金标准,尽管其敏感性存在争议,并且实践模式在样本长度以及是否进行单侧或同时进行双侧活检方面仍然有所不同。一些研究报道了超声对TAB的敏感性更高,增加了时间效率和成本效益的好处,促进超声波的诊断使用。MRI和甚至PET-CT协议为较少侵入性的诊断测试提供了额外的选择。
■对视力威胁的GCA进行急性治疗,紧急入院静脉注射甲基强的松龙,长期高剂量口服皮质类固醇仍然是治疗的标准,尽管常见且有时严重的副作用。保留类固醇的替代品如托珠单抗的使用变得越来越普遍,并且正在研究其他药物。
UNASSIGNED: Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting the medium and large-size arteries, and may present with a range of ophthalmic findings. This review will cover GCA epidemiology, pathophysiology, clinical presentation, diagnostic workup, and treatment.
UNASSIGNED: GCA is commonly found in elderly patients and individuals of Scandinavian descent. Recent publications suggest it may be more common in African Americans and Hispanics than previously thought. It is very rare in Asian and Middle-Eastern populations, and there is little data regarding African populations. Genetic studies have identified increased risk associated with HLA-DRB1*04. Rather than a response to a specific antigen such as varicella zoster virus, current immunology research suggests that GCA results from changes associated with the aging immune system.
UNASSIGNED: Arteritic anterior ischemic optic neuropathy is the most common ophthalmic manifestation of GCA, but central or branch retinal artery occlusion, ophthalmic artery occlusion, cranial neuropathies causing diplopia, and more rarely anterior segment ischemia and anisocoria may also occur. Clinical testing including visual field testing, OCT, OCT-A, ICG and fluorescein angiography can be helpful in suggesting a diagnosis in addition to the clinical exam.
UNASSIGNED: GCA is ultimately a clinical diagnosis, but it is usually supported with lab results, pathology, and/or imaging. Temporal artery biopsy (TAB) remains the gold standard diagnostic test although its sensitivity is debated and practice patterns still vary with respect to sample length and whether unilateral or simultaneous bilateral biopsies are performed. Some studies have reported higher sensitivity of ultrasounds over TAB, with added benefits of time efficiency and cost effectiveness, promoting the diagnostic use of ultrasounds. MRI and even PET CT protocols offer additional options for less invasive diagnostic testing.
UNASSIGNED: Vision-threatening GCA is treated acutely with emergent admission for intravenous methylprednisolone, and long-term high dose oral corticosteroids remain the standard of care, despite common and sometimes serious side effects. The use of steroid-sparing alternatives such as tocilizumab is becoming more common and additional agents are being investigated.