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多发性大动脉炎合并颈动脉闭塞儿童的临床特征及预后分析

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分析儿童多发性大动脉炎合并颈动脉闭塞的临床特征及预后.收集2013-2023年于首都儿科研究所附属儿童医院和内蒙古医科大学附属医院儿科首次诊治c-TA合并颈动脉闭塞患儿的临床资料及随访情况.本研究共纳入4例患儿,均为女性,年龄为(13.25±1.71)岁,从发病到诊断的时间为(8.14±11.19)个月,其主要症状和体征为头晕、头痛、胸部不适、失语、肢体活动障碍、高血压、四肢血压不对称、血管杂音或震颤、桡动脉搏动减弱、肌力下降.4例患儿均出现C反应蛋白、红细胞沉降率增高.影像学结果显示:4例患儿中3例为双侧颈动脉闭塞,1例为单侧颈动脉闭塞.脑血管受累共3例,并伴有全身多部位的动脉受累,主要累及双侧锁骨下动脉、头臂干动脉,双侧肾动脉、双侧髂动脉、大脑中动脉.4例患儿经糖皮质激素、免疫抑制剂治疗均有效.对患儿随访(42.25±52.54)个月,随访结果显示,原受累动脉仍存在不同程度的闭塞,较治疗前无进展,无新发动脉受累.3例原有肢体、语言障碍患儿病情逐步改善.综上,c-TA合并颈总动脉闭塞儿童可致多支血管受累,临床表现多为全身症状及血管病变引发的相应供应脏器的缺血表现,易合并脑梗,闭塞血管难以恢复.
Clinical features and prognosis of children with multiple Takayasu's arteritis complicated with carotid artery occlusion
This study aimed to analyze the clinical characteristics and prognosis of Takayasu's arteritis(TA)with carotid artery occlusion in children.This study collected clinical data and follow-up information on the first diagnosis and treatment of c-TA combined with carotid artery occlusion in pediatric patients at the Children's Hospital affiliated with the Capital Institute of Pediatrics and Inner Mongolia Medical University Affiliated Hospital from 2013 to 2023.This study included four female patients with a mean age of(13.25±1.71)years old.The time from onset to diagnosis was(8.14±11.19)months.Their main clinical symptoms and signs were dizziness,headache,chest discomfort,aphasia,dyskinesia,impaired mobility of the limbs,hypertension,asymmetry of blood pressure in the limbs,vascular murmurs or tremors,weakened radial artery pulsation,and decreased muscle strength.All four children showed elevated levels of C-reactive protein and erythrocyte sedimentation rate.The medical imaging results showed that among the four patients,three had bilateral carotid artery occlusion,and one had unilateral carotid artery occlusion.There were three cases of cerebrovascular involvement,accompanied by arterial involvement in multiple parts of the body,mainly involving bilateral subclavian arteries,cephalic trunk arteries,bilateral renal arteries,bilateral iliac arteries,and middle cerebral arteries.Four children were effectively treated with glucocorticoids and immunosuppressants.These children were followed up for a period of(42.25±52.54)months,which showed that the original affected artery still had varying degrees of occlusion,with no progression from the pre-treatment period and no new arterial involvement.The condition of three children with pre-existing physical and language disorders gradually improved.In summary,children with c-TA combined with carotid artery occlusion can cause involvement of multiple blood vessels.Their clinical manifestations are mostly systemic symptoms and ischemia of corresponding supply organs caused by vascular lesions,which are prone to be combined with cerebral infarction,and their occluded blood vessels are difficult to recover.

ChildrenTakayasu's arteritisArteria carotis communisOcclusion

贺宝平、赖建铭

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内蒙古医科大学附属医院,呼和浩特 010010

首都儿科研究所附属儿童医院,北京 100020

儿童 多发性大动脉炎 颈总动脉 闭塞

2024

中华预防医学杂志
中华医学会

中华预防医学杂志

CSTPCD北大核心
影响因子:1.652
ISSN:0253-9624
年,卷(期):2024.58(12)