Analysis of clinical features of 14 infants with Takayasu arteritis / 中华实用儿科临床杂志

ABSTRACT

Objective To improve the understanding and diagnosis and treatment level of infant with Takayasu arteritis (TA) by analyzing the clinical features of 14 pediatric patients and reviewing related articles.Methods The clinical and follow-up data of infants with TA who were admitted to the Children's Hospital Affiliated to Capital Institute of Pediatrics between July 2016 and May 2019 were retrospectively analyzed.By reviewing related articles,the clinical features of this disease were summarized.Results The age of 14 patients (including 6 males and 8 females) were between 1 month and 23 days and 28 months.The most common clinical manifestations were fever in 10 cases (71.4％),hypertension in 9 cases (64.3％),weak or no pulse in 5 cases (35.7％).According to the clinical type of lesion vessels,11 cases (78.5％) were generalized type,3 cases (21.4％) were brachiocephalic artery type,and there was no thoracic abdominal aorta or single pulmonary artery type in this group.Among 14 infants with TA,12 cases had common carotid artery,carotid artery,subclavian artery,coronary artery and its branches (anterior descending branch,circumflex branch) involved (85.7％);11 cases had renal artery involved (78.6％);9 cases had radial artery involved (64.2％);8 cases had abdominal aorta involved (57.1％);6 cases had descending aorta involved (42.9％);6 cases had thoracic aorta involved (42.9％);6 cases had superior mesenteric artery involved (42.9％);5 cases had femoral artery involved (35.7％);5 cases had pulmonary artery involved (35.7％);and 4 cases had brachial artery involved (28.6％).In those 14 patients,11 cases were misdiagnosed,and 3 cases had unclear diagnosis,with misdiagnosis duration of 18 days to 2 months.In misdiagnosed cases,8 cases were misdiagnosed as atypical Kawasaki disease.Among those 14 cases,the ranges of most lesions were gradually decreased,and the slightly involved vessels even completely returned to normal state after treatment in 7 cases.The vascular imaging showed no significant exacerbation or imnprovement in 4 cases.Nine cases developed hypertension,the blood pressure of whom could be controlled within normal range with hypotensive drugs which could not be interrupted.Physical examination found weak or no pulse in 5 cases who were not improved.Among 14 patients,7 cases showed normal development,while the height and body mass of another 7 cases were the 25th percentile below those of normal children of the same age.All 14 patients were followed up for 2-22 months and received regular treatment without recurrence.Conclusions TA patients aged less than 3 years tend to have more blood vessels involved,be in serious condition and have higher rate of misdiagnosis.The disease can be controlled quickly after treatment,but vascular diseases may be developed easily.Some patients have a poor prognosis.