大动脉炎并不比小血管炎简单PPT演示课件

.,1,关于大动脉炎(LVV),.,2,我的问题,1. 基本概念：LVV定义和分型？2. LVV的评估？3. LVV的治疗？,.,3,1. 基本概念：LVV定义和分型？2. LVV的评估？3. LVV的治疗？,.,4,.,5,TAK vs. GCA,.,6,临床分类标准：1990 ACR,sensitivity 90.5% ，specificity 97.8% 但是诊断延迟！,.,7,.,8,TAK type,type 1: branches of the aortic arch; type 2a, ascending aorta,aortic arch and its branches; type 2b, ascending aorta, aortic arch and its branches and thoracic descending aorta; type 3, descending thoracic aorta, abdominal aorta and/or renal arteries; type 4, abdominal aorta and/or renal arteries; type 5, combined features of types 2b and 4. in addition, involvement of the coronary and pulmonary arteries should be indicated.,分型的意义在于？ 图,.,9,TAK分型的意义？,.,10,1. 基本概念：LVV定义和分型？2. LVV的评估？3. LVV的治疗？,（1）目前用于临床研究的评估手段（2）临床上怎么评估？（3）影像学评估,.,11,临床研究的评估手段（1）,血管炎活动度评估：1994 the BVAS v3/WG, 2001 Disease Extent Index (DEI), 血管炎损害评估：1997 VDI2004 combined damage assessment (CDA),.,12,临床研究的评估手段（2）,生活质量评估（QOL）：SF-36 EuroQol five-dimensions questionnaire (EQ-5D) no correlations between SF-36 scores and angiographic type, disease duration, ESR or CRP levels in the TAK patients. A negative correlation was observed between the VDI and SF-36 scores,.,13,临床研究的评估手段（3）TAK-specific disease activity measures,1994 NIH2004 DEI-Takayasu (DEI.Tak)2006 Indian Takayasu Clinical Activity Score (ITAS 2010),.,14,TAK-specific damage measures,.,15,临床上怎么评估？,.,16,image,FDG-PET MRIUSCT,.,17,1.分析包括21项研究，413例LVV，127例GCA，197例TAK2.Control：299名患者，226例肿瘤，31例其他（感染18，RA 6，AAV 5），44例不详3.156/416：接受治疗4.Positice PET:using authors criteria,.,18,.,19,.,20,PET用于GCA诊断：敏感性 0.89，特异性0.98，且研究一致性好,.,21,PET用于TAK活动性评估：敏感性 0.86，特异性0.73，且研究一致性差,.,22,PET用于TAK活动性评估：均用NIH scale评估活动度。敏感性 0.86 0.84，特异性0.73 0.84.,.,23,PET用于TAK活动性评估与其他指标的一致性：2.Significant vascular uptake(moderate and high ) inNo markers of activity vs. 3/3 markers of activity: 8/12 vs. 14/16(67% vs. 88%),.,24,image,FDG-PET MRA: for structure and wall edemaActive/inactive: sen 100%,spe 89%; PPV 92%,NPV 100%. （？） MRA reveal wall edema：active 94% vs. inactive 56% ，且与ESR及CRP无关sustained vessel wall oedema reflects both activity and damage, although vessel wall oedema occurs early in the pre-stenotic inflammatory stage of the disease US: for structure and wall edema；surface of bodyCTA: for structure （more accurate）no reports on CTA vs.detailed disease acticvity,.,25,.,26,Outcome measure,.,2