Clinical Characteristics And Pathogenesis Of Takayasu 's Disease And Giant Cell Arteritis

Clinical analysis of 411 patients with Takayasu arteritis in Peking Union Medical College HospitalObjective We conducted this retrospective study to estimate the clinical characteristics of patients in Peking Union Medical College Hospital (PUMCH) and learn more about the disease’s spectrum of Chinese patients with Takayasu arteritis (TAK). Explore the possible risk factors for complications in patients with TAK and compare the clinical characteristics of patients in our center with other studies.Methods Four hundred and eleven patients with TAK in PUMCH were studied and their demographic data, clinical manifestations, the laboratory, vascular imagings, treatment and outcome were retrospectively reviewed. TAK patients were divided into different subgroups according to Lupi-Herrera and Numano classification, respectively. Comparisons were conducted between different genders. The data was also compared among patients of different vascular classification. Risk factors for complications (hypertension, aortic valve insufficiency, retinopathy, or hemangioma) were analyzed in patients with TAK. We also summarized the types of classification and demographic characteristics of TAK patients from research at home and abroad. Mann-Whitney U-test or Student’s t-test, chi-squared test or Fisher’s exact test were used for the comparison between two groups. Logistic regression analysis model were applied to do the multivariate analysis.Resluts The mean age at onset of disease was 23 years old, and the ratio of male to female was 1:3.8 in our patients. Subclavian artery and carotid artery were the most common involved arteries, other commonly involved vessels include abdominal aorta, renal arteries, brachiocephalic artery, thoracic aorta, mesenteric/celiac artery, vertebral artery, aortic arch, iliac artery, ascending aorta, pulmonary artery and the coronary arteries. Regarding the vascular lesions, stenotic/thickening of arterial wall/occlusive were significantly more frequent than aneurysmal/vasodilation lesions. The involvement of carotid and subclavian artery were more frequent in female patients (P<0.01), but the complication of hypertension was more common in male patients (P=0.025).Patients of wide type (56.0%) or type Ⅴ (61.8%) constitute the majority of this group of patients. These patients were younger at the onset of disease (P=0.001), but they had a higher proportion of hypertension and congestive heart failure than other patients (P<0.001; P=0.110). We observed that the mean level of hemoglobin (Hb) was higher in patients of type V (P=0.035), while the level of erythrocyte sedimentation rate (ESR) was significantly lower than other patients (P=0.019).In patients with complications (hypertension, aortic regurgitation, hemangioma, or retinopathy), the proportion of male patients was significantly higher than that of patients without complication (P<0.001). Patients with complications had more frequent involvement of abdominal aorta and renal artery, but less involvement of innominate artery and carotid artery (P=0.007; P<0.001). The levels of ESR, CRP and platelet (PLT) were all significantly lower in patients with complications at onset of disease (P<0.01). Multivariate analysis demonstrated that men (OR:2.937, P=0.01), the involvement of abdominal aorta (OR=2.189, P=0.029) and renal artery (OR=4.964, P<0.001) were risk factors of complications in patients with TAK, while the elevated level of CRP at onset was a protective factor in patients with complications (OR=0.987, P <0.001).When compared with the studies of TA at home and abroad, we observed that patients with TAK in our center were younger than other groups at onset of disease. The proportion of patients with wide-type was higher than that in other studies in China, while the proportions of type Ⅰ to Ⅴ were between the proportions reported in studies abroad.Conclusion The majority of TAK patients in our center were female, and the mean age of onset was younger than other groups. Range of vascular involvement in this group of TAK patients was wide. Men had higher risk of complications in this series of TAK patients. The lower systemic inflammatory response at onset of disease might be associated with the occurrence of complications in TAK patients.A retrospective study of Chinese patients with giant cell arteritis (GCA): clinical features and risk factors for severe ischemic manifestationsA retrospective study was performed on 70 giant cell arteritis (GCA) patients in Peking Union Medical College Hospital (PUMCH). The aim of this study was to describe the clinical features of these Chinese GCA patients, and explore the possible associated factors for severe ischemic manifestations. Medical charts of all patients were reviewed, and the demographic, clinical and laboratory data were analyzed. The mean age at disease onset was 65.2 years old, and the ratio of male to female was 1:1. Fever and headache were most prominent symptoms at disease onset, which occurred in 51.4% and 30.0% of patients respectively. Common manifestations at diagnosis were constitutional symptoms (85.7%), headache (68.8%), visual impairment (38.6%), jaw claudication (30%), scalp tenderness (30%) and concurrent polymyalgia rheumatic (27.1%). No significant difference in clinical manifestations between genders was observed. Comparisons between patients with and without severe ischemic manifestations including jaw claudication, permanent visual loss, or cerebrovascular accident had shown that fever and asthenia were significantly less frequent in patients with severe ischemic manifestations (P=0.006 and P=0.023, respectively), and the mean value of erythrocyte sedimentation rate (ESR) was significantly lower in patients with severe ischemic manifestations than patients without (P=0.001). History of smoking was more frequent in patients with severe ischemic manifestations (P=0.038). By multivariate logistic regression, the only predictor with statistical significance for the occurrence of severe ischemic manifestations was the low level of ESR at diagnosis.This is the largest group of GCA patients from China so far. When compared our data with patients reported in the literature, this series of GCA patients were younger without female predominance. The clinical manifestations of patients in this report were similar to other studies except for a higher prevalence of constitutional symptoms. The results of this study indicated that lower systemic inflammatory response might be associated with severe ischemic damagesThe study of Th 17 and CD161+T in patients with Takayasu’s arteritisObjective To investigate the levels of Th17、CD4+CD161+T and CD8+CD161+T cells in peripheral in blood mononuclear cells(PBMCs) of patients with Takayasu’s arteritis (TAK), Then analyze their correlations with disease activity of TAK.Methods Samples were collected from 29 patients with TAK and 20 healthy controls (HC) in Peiking Union Medical College Hospital (PUMCH) from June 2015 to December 2015. The proportions of each group (Th17, CD4 + CD 161 + T and CD8+ CD161+T cell) in peripheral blood mononuclear cell were detected by the flow cytometry. The percentages of these cells were compared between TAK patients and HC.Results The mean level of Th17/CD4+T (1.095%) was significantly up-regulated in patients who had elevateded ESR when compared with HC (0.491%) (P=0.023) However, the average level of Th17/CD4+T in all patients (0.506%) was not significantly increased when compared with HC (P>0.05). The ratios of the mean levels of CD4+CD161+T/CD4+T (11.5±5.2%) and CD8+CD161+T/CD8+T (17.9±11.4%) were not significantly increased in patients with TAK. (all P>0.05)Conclusion TAK patients with elevated ESR had a higher level of Th17. Th17 may has some relevance with systemic inflammatory response in TAK. However, Th17 can’t accurately assess the overall disease activity in patients with TAK. CD161+T cells showed no abnormal levels in patients with TAK.