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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-3417

摘要内容如下：

背景

巨细胞动脉炎（GCA）是50岁以上人群中最常见的系统性血管炎。诊断的任何延误都会损害患者的生活质量，并可能导致永久性损伤，尤其是视力丧失。

客观

使用颞动脉彩色多普勒超声作为一线诊断测试，颞动脉活检（TAB）作为次要测试，医师专业知识作为参考方法，评估GCA的诊断策略。

设计

前瞻性多中心研究，随访2年。（ClinicalTrials.gov：NCT02703922）

设置

患者由他们的全科医生或眼科医生转介给参与中心之一的在GCA诊断和管理方面具有丰富经验的医生:4家综合医院和2家大学医院。

病人

165例临床高度怀疑GCA的患者，年龄79岁（IQR，73至85岁）。

干预

诊断程序是超声，在激素治疗开始后7天内进行。只有超声检查阴性的患者才接受TAB。

测量

超声检查发现双侧颞部晕征为阳性。将超声和TAB结果与医生根据临床表现和其他影像学诊断的贲门癌进行比较。

结果

44%、17%和21%的患者分别通过超声、TAB和临床专家和/或其他影像学检查确诊为贲门癌。他们的诊断在1个月时保持不变，对于那些有可用随访数据的患者，诊断在2年时保持不变。18%的患者做出了替代诊断。在临床诊断为GCA的患者中，超声阳性患者的比例为54%（95%CI，45%-62%）。

局限性

样本量小，超声和TAB结果无盲法，缺乏客观的金标准对照，诊断策略单一。

结论

通过使用颞动脉超声作为临床高度怀疑贲门癌患者的一线诊断工具，避免了对超声阳性患者的进一步诊断检查。

主要资金来源

招标“ 2014年普瓦图-夏朗德研究”。

英文原文如下：

Abstracts

BACKGROUND  Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss.

OBJECTIVE  To evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method.

DESIGN  Prospective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922).

SETTING  Patients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals.

PATIENTS  165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years).

INTERVENTION  The diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB.

MEASUREMENTS  Bilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging.

RESULTS  Diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%).

LIMITATION  Small sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy.

CONCLUSION  By using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided.

PRIMARY FUNDING SOURCE  Tender "Recherche CH-CHU Poitou-Charentes 2014."

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