Takayasu's arteritis H1964
1. Á¤ÀÇ
aortic arch¿Í ±× branch¸¦ ÁַΠħ¹üÇÏ´Âmedium- and large-sized arteryÀÇ inflammatory
and stenotic diseaseÀÌ´Ù. aortic arch¸¦ ÁַΠħ¹üÇϹǷΠaortic arch syndromeÀ̶ó°íµµ
ÇÑ´Ù.
2. ¹ß»ý ¹× À¯º´
Takayasu's arteritis´Â µå¹®ÁúȯÀ̸ç temporal arteritisº¸´Ù ´ú ÈçÇÏ´Ù.
û¼Ò³â±â ÀþÀº ¿©ÀÚ¿¡¼ °¡Àå ¸¹ÀÌ ¹ß»ýÇÑ´Ù.
µ¿¾çÀο¡¼ ´õ ÈçÇÏÁö¸¸ ƯÁ¤ Á¾Á·À̳ª Áö¿ª¿¡ ±¹ÇѵÇÁö ¾Ê´Â´Ù.
3. º´Å»ý¸® ¹× º´ÀÎ
* Tab317-5: °¡Àå Àß Ä§¹üµÇ´Â Ç÷°ü ¹× ÀÓ»óƯ¡
subclavian(mc) > common carotid > abdominal aorta > renal
aorta major branchÀÇ Ä§¹üÀº ¿øÀ§ºÎº¸´Ù´Â originÇÏ´ÂÀå¼Ò¿¡ ´õ µÎµå·¯Áø´Ù.
inflammatory mononuclear cell infiltration(°£È¤ giant cells)À» µ¿¹ÝÇÏ´Â panarteritisÀ̸ç
marked intimal proliferation and fibrosis, media scarring & vascularization, elastic laminaÀÇ
disruption & degradationÀ» º¸ÀδÙ. thrombosisÀÇ À¯¹«¿Í »ó°ü¾øÀÌ luminal narrowingÀÌ
¹ß»ýÇÑ´Ù.
vasa vasorumÀÌ ÈçÈ÷ ħ¹üµÈ´Ù.
4. ÀÓ»ó ¹× °Ë»ç½Ç ¼Ò°ß
Takayasu's arteritis´Â ±¹¼ÒÁõ»óÀ» ÀÏÀ¸Å³ »Ó¸¸ ¾Æ´Ï¶ó Àü½ÅÀû Áõ»óµµ ÀÏÀ¸Å²´Ù.
Àü½ÅÀû Áõ»óÀ¸·Î´Â malaise, fever, night sweats, arthralgias, anorexia, and wt loss µîÀÌ
ÀÖ´Ù.À̵é Áõ»óÀº Ç÷°üħ¹üÀÌ ÀÖ±âÀü¿¡ ³ªÅ¸³ª±âµµ ÇÑ´Ù. ħ¹ü Ç÷°ü, ƯÈ÷ subclavian artery
°¡ ħ¹üµÇ¾úÀ» ¶§ pulse´Â ÈçÈ÷ ¾ø´Ù.
ÀÓ»óÀû °æ°ú´Â Àü°Ý¼ºÀϼöµµ ÀÖ°í, ¼¼È÷ ÁøÇàÇÒ¼öµµ ÀÖ°í, stabilizeÇÒ¼öµµ ÀÖ´Ù. ÇÕº´ÁõÀº
ħ¹üÇ÷°üÀÇ ºÐÆ÷¿Í °ü·ÃÇÏ¿© ¹ß»ýÇϴµ¥ »ç¸ÁÀº ÁÖ·Î congestive heart failure¿Í CVA¿¡
ÀÇÇÑ´Ù.
Ư¡ÀûÀÎ °Ë»ç½Ç ¼Ò°ßÀº ESRÀÇ Áõ°¡, mild anemia, immunoglobulin levelÀÇ Áõ°¡ÀÌ´Ù.
5. Áø´Ü
Áø´ÜÀÇ ½ÃÀÛÀº ÀþÀº ¿©ÀÚ¿¡°Ô¼ peripheral pulse°¡ °¨¼ÒÇϰí Ç÷¾ÐÀÇ ºÒÀÏÄ¡, arterial bruit°¡
µé¸±¶§ °·ÂÇÏ°Ô ÀǽÉÀ» ÇÏ´Â °ÍÀÌ´Ù. Áø´ÜÀº Ư¡ÀûÀÎ arteriographic patternÀ¸·Î ÇÑ´Ù.
: irregular vessel walls, stenosis, poststenotic dilatation, aneurysm formation, occlusion,
evidence of increased collateral circulation
½ÅÀå¿¡ ±Ý±â°¡ ¾ø´Ù¸é arterial diseaseÀÇ Á¤µµ¿Í ºÐÆ÷¸¦ ¿ÏÀüÈ÷ ÆÄ¾ÇÇϱâ À§ÇØ complete
aortic arteriography¸¦ ½ÃÇàÇØ¾ß ÇÑ´Ù.
6. Ä¡·á
º¸°íµÈ »ç¸Á·üÀº 10%¹Ì¸¸¿¡¼ 70%±îÁö ´Ù¾çÇÏ´Ù. ºñ·Ï glucocorticoid 40-60mg/day°¡
Áõ»óÀ» ¿ÏÈÇÏÁö¸¸ ´Üµ¶À¸·Î »ýÁ¸·üÀ» Çâ»ó½ÃŰ´ÂÁö¿¡ ´ëÇÑ È®Á¤ÀûÀÎ ¿¬±¸´Â ¾ø´Ù.
glucocorticoid¿Í ÇùÂøÇ÷°ü¿¡ aggressive surgical and/or angioplastic approachÀÇ º´ÇÕÄ¡·á
·Î »ýÁ¸·üÀÇ »ó´çÇÑ Çâ»ó°ú strokeÀ¸·Î ÀÎÇÑ morbidity, renal artery stenosis·Î ÀÎÇÑ °íÇ÷¾Ð,
ischemic viscera and limbÀ¸·ÎÀÇ blood flowÇâ»óÀ» °¡Á®¿Ô´Ù°í º¸°íÇÏ¿´´Ù. ÀÌ·¯ÇÑ Ä¡·á¸¦
ÅëÇÏ¿© ´ëºÎºÐÀÇ ÃÖ±Ù »ç¸Á·üÀº 10%¹Ì¸¸ÀÌ´Ù.
glucocorticoid¿¡ ¹ÝÀÀÇÏÁö ¾Ê´Â »ç¶÷Àº methotrexate 25mgÀ» ÁÖ 1ȸ »ç¿ëÇÏ¿© ÁÁÀº °á°ú¸¦
¾ò¾ú´Ù. ±×·¯³ª confirmÇϱâ À§Çؼ´Â long-term study°¡ ÇÊ¿äÇÏ´Ù.