摘要
大动脉炎(Takayasu arteritis,TAK)为慢性自身免疫性疾病,具有起病早、病程长、致残率高、疾病负担重的特点,严重影响患者身心健康和生活质量。目前尚无大动脉炎慢病管理的指南或专家共识。因此,我们制定了国内首部大动脉炎全病程多学科慢病管理专家共识,旨在为相关学科的临床医师规范诊治流程、提高诊疗水平、改善疾病预后。本共识的主要观点为:(1)大动脉炎发病早、死亡率高,要重视疾病的早期筛查,重点人群为中青年伴血压异常、脉搏减弱或无脉、颈痛或颈部血管杂音;(2)建议采用2022年ACR/EULAR分类标准诊断大动脉炎;(3)全面评估的内容包括疾病活动性、血管损伤及血管损伤相关重要脏器功能和结构、疾病危险程度、合并症以及生命质量;(4)建议疾病活动度评估方法采用Kerr评分;(5)建议进行全面的血管评估,超声、MRA、CTA和PET/CT等均可作为大动脉炎诊断和随访评估的影像学方法;(6)MRA显示管壁增厚、T2加权高信号以及管壁强化,CTA显示血管壁增厚、强化、低衰减环,PET/CT显示管壁SUV值升高均提示管壁炎症;(7)建议在疾病诊断和随访中根据临床表现及受累血管部位、严重程度进行重要脏器的功能和结构评估;(8)大动脉炎治疗应以风湿免疫科为主导,在多学科诊疗前提下建立“以患者为中心”的慢病管理模式,实现全病程达标治疗;(9)糖皮质激素(GCs)是诱导缓解的基础用药,需联合改善病情抗风湿药(DMARDs)治疗来实现疾病缓解,注意药物疗效和副作用;(10)建议血运重建在内科充分抗炎治疗后疾病控制稳定的前提下由多学科团队(multidisciplinary teams,MDT)共同商议制定决策,术后仍需序贯内科的治疗与评估;(11)建议有妊娠需求的患者由MDT团队全面评估,选择合适的妊娠时机,并在妊娠期和分娩期密切监测与随访;(12)建议疫苗接种在疾病稳定期进行;在使用GCs和DMARDs�
Takayasu arteritis(TAK)is a chronic autoimmune disease with the characteristics of early onset,long course,high disability rate and heavy disease burden,which seriously affects the physical and mental health and quality of life of patients.So far,there are no guidelines or expert consensus on the chronic disease management of TAK.Therefore,we have developmented the first domestic multidisciplinary recommendations on the chronic diseases management throughout the entire course ofTAK,aiming to standardize the diagnosis and treatment process,improve the diagnosis and treatment level,and improve the prognosis of the disease for clinicians in relevant disciplines.The keypoints of this consensus include:(1)TAK has an early onset and high mortality rate.Early screening of the disease with a focus on middle-aged and young people with abnormal blood pressure,weakened or absent pulse,neck pain,or cervical vascular murmurs should be emphasized;(2)2022 ACR/EULAR classification standard is recommended for the diagnosis of TAK;(3)The comprehensive assessment includes disease activity,vascular injury,important organ structures and functions related to vascular injury,disease risk,comorbidities,and quality of life;(4)Kerr score is recommended to assess disease activity;(5)A comprehensive vascular assessment is recommended,ultrasound,MRA,CTA,and PET/CT can all be used as imaging methods for the diagnosis and follow-up evaluation of TAK;(6)Wall thickening,T2 weighted high signal,and wall enhancement on MRA;appearance of thickening,enhancement,and low attenuation loops in the vascular wall on CTA;and an increase in SUV value of the wall on PET/CT,indicating wall inflammation;(7)In disease diagnosis and follow-up,the structure and function of important organs are recommended to be evaluated based on clinical manifestations,affected vascular sites,and severity;(8)The treatment of TAK should be dominated by the rheumatologists,and a“patientcentered”chronic disease management model should be established under a multidisciplinary di
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2023年第5期633-654,共22页
Fudan University Journal of Medical Sciences
基金
国家自然科学基金面上项目(82271834)
上海市科委“科技创新行动计划”面上项目(21Y11909100)
复旦大学附属中山医院临床研究专项重点项目(2020ZSLC14)
复旦大学附属中山医院智慧医疗专项(2020ZHZS11)。
关键词
大动脉炎(TAK)
慢病管理
共识
Takayasu arteritis(TAK)
chronic disease management
recommendation
