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69-9-第九节 预 后
一、GCA复发以及治疗失败的定义: s( ~( t( \% w& ~) k' I
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GCA复发:GCA复发是指ESR由正常升至)40 mm/h,加上以下GCA的特点中的至少一项,这些表现有GCA引起而非其他疾病所致。这些表现为:①发热,T) 38℃至少一周;②出现PMR;③头痛、头皮痛或触痛;④失明;⑤下领或口周疼痛;⑥肢端间歇运动障碍;⑦与血管炎一致的动脉造影异常;⑧脑缺血或脑梗死;⑨其他证实为GCA特点的表现。
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GCA治疗失败:出现2次不同的复发,或使用泼尼松治疗期间出现复发,且较上一有效剂量加大10mg治疗仍不能改善。
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二、预后 & t3 [" B7 N0 x
/ _! u: w# N# }! C) U PMR一般为2年期的自限性疾病,较少发展为GCA。GCA的视力受损通常是不可逆,平均需治疗 2年,部分患者需治疗5年或更多。早期报道GCA合并PMR的老年患者病死率为1% -12%,近年来由于早期诊断和治疗的改善,其病死率和同年龄组常人无差异。
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