[Clinical characteristics of middle-age and elderly patients with active Takayasu arteritis disease].

摘要

Objective: To draw attention to the diagnosis of active Takayasu arteritis (TAK) in middle-aged and elderly patients and to analyze the clinical characteristics of this population. Methods: Clinical data of 106 patients newly diagnosed with TAK at Beijing Chao-Yang Hospital, Capital Medical University, between 2017 and 2025 were retrospectively collected; 11 patients aged over 50 years (2 men and 9 women) were enrolled in this study. Onset characteristics, medical history, clinical manifestations, laboratory findings, and imaging features were collected and analyzed. Disease activity was evaluated, treatment regimens and prognosis were recorded, and all patients underwent at least one follow-up. Results: Among patients first diagnosed with TAK at this single center, middle-aged and elderly patients with active TAK accounted for 10.40% (11/106) during the same period, with a median age at diagnosis of 61 years. Among them, 6 patients (6/11) were over 60 years old. The median time from symptom onset to diagnosis was 13 months (interquartile range: 12, 36 months). Although all 11 patients had multiple arterial involvements, none underwent complete evaluation of all arteries covered by the international criteria. Among the 8 patients who underwent CT pulmonary angiography (CTPA) or chest contrast-enhanced CT, all showed pulmonary artery luminal stenosis. All 8 patients who underwent contrast-enhanced magnetic resonance pulmonary angiography (MRPA) exhibited pulmonary artery wall thickening with enhancement and luminal stenosis. Of the 9 patients who underwent PET-CT, 7 showed pulmonary artery hypermetabolism. Among the 4 patients with elevated levels of multiple autoantibodies, 2 were male (2/2) and 2 were female (22.2% of female patients, 2/9). Moreover, both male patients had severe TAK-related complications (one with an abdominal aortic aneurysm and the other with pulmonary hypertension). Conclusion: Active TAK can occur in individuals over 60 years of age and the disease may be more severe in middle-aged and elderly male TAK patients. Middle-aged and elderly patients with active TAK require comprehensive evaluation of arterial involvement with modalities such as ultrasound, so as to enhance the capability of clinical differential diagnosis. For patients presenting primarily with respiratory symptoms, CTPA and MRPA should be performed to clarify pulmonary artery involvement in TAK. 目的： 关注中老年活动性大动脉炎（TAK）的诊断，分析此类患者临床特点。 方法： 回顾性收集2017—2025年首都医科大学附属北京朝阳医院首次确诊TAK的患者资料106例，纳入其中年龄>50岁的TAK患者11例，其中男2例，女9例。采集并分析其发病特点、病史、临床表现、实验室检查、影像学特征，评估TAK活动性，记录治疗方案及预后，并对患者进行至少1次随访。 结果： 在单中心首次确诊的TAK患者中，中老年活动性TAK占同期的10.40%（11/106），中位诊断年龄61岁，>60岁的患者6例（6/11）。从发病到确诊的中位时间13（12，36）个月。尽管11例患者均存在多个动脉支受累，但所有患者都未能完整评价国际标准涵盖的所有动脉。8例患者完善CT肺动脉造影（CTPA）或胸部增强CT，均存在肺动脉管腔狭窄；8例行肺动脉增强核磁（MRPA）均存在肺动脉管壁增厚伴强化、管腔狭窄；9例行PET-CT，其中7例肺动脉呈高代谢。在多种自身抗体水平升高的4例患者中，男2例（2/2）、女2例（2/9），并且2例男性患者均出现严重TAK相关并发症（1例腹主动脉瘤、1例肺动脉高压）。 结论： 活动性TAK可以出现在年龄>60岁的人群中，中老年男性TAK患者的病情严重程度可能更重。中老年活动性TAK患者需要应用超声等手段全面评价动脉情况，提升临床鉴别诊断的能力；以呼吸系统症状为主就诊的患者，应注重完善CTPA、MRPA以明确TAK肺动脉受累情况。.