COMPARATIVE ASSESSMENT OF THE PROGRESSION AND PROGNOSIS OF NONSPECIFIC AORTOARTERITIS WITH DIFFERENT TREATMENT APPROACHES

The purpose of the work: comparative assessment of the progression and prognosis of nonspecific aortoarteritis (NAA) with different treatment approaches. Were observed 300 patients. Thus, we believe that it is necessary to determine the stage of the process according to clinical and laboratory signs, however, given the diversity and multiplicity of lesions in NAA, all patients with a chronic stage should undergo pulse therapy in a hospital before surgery, and if there is no need for surgery, pulse therapy and methotrexate for 3 months. All patients with diagnosed acute and subacute stages should receive pulse therapy and methotrexate parenterally for at least 3 months, after which they can be operated on. This indicates that in NAA, inflammation is permanent, but expressed to varying degrees, and the chronic stage is conditional. Threshold levels for laboratory remission of NAA: ESR is less than 21 mm/h, CRP is less than 11 mg/l at AUC = 0.91 (sensitivity =90%, specificity =85%) and 0.88 (sensitivity =95%, specificity =80%), respectively. Evidence was obtained on the effectiveness of pulse therapy at any stage of NAA, which proved 1) the permanence of inflammation and the conditionality of the chronic stage, 2) the negative effect of surgery without prior pulse therapy, since the progression of NAA against the background of pulse therapy decreased 4.3 times with conservative (from 26.3% to 6.1%) and 3.8 times (from 49.4% to 13.1%) during surgical treatment. The treatment strategy for all patients with NAA consists in prescribing pulse therapy with cyclophosphane and methylprednisolone: both in the chronic stage and in the presence of indications for surgery, as well as in the acute and subacute stages. This strategy has made it possible to stabilize inflammation, control the disease and prevent complications.本研究旨在对比评估不同治疗方案下非特异性主动脉炎（nonspecific aortoarteritis, NAA）的病情进展与预后情况。本研究共纳入300例受试患者。研究团队认为，需依据临床与实验室指标明确疾病进程分期；但鉴于非特异性主动脉炎的受累范围广泛、病变类型多样，所有处于慢性期的患者在接受手术治疗前，均需在院内接受脉冲治疗（pulse therapy）；若无需手术，则需接受脉冲治疗联合甲氨蝶呤（methotrexate）治疗3个月。所有确诊为急性期及亚急性期的患者，均需接受至少3个月的静脉脉冲治疗联合胃肠外途径给予的甲氨蝶呤治疗，后续可评估手术指征。上述结果提示，非特异性主动脉炎的炎症反应呈持续存在状态，但炎症程度存在个体差异，且慢性期的分期具有相对性。非特异性主动脉炎实验室缓解的临界值为：红细胞沉降率（erythrocyte sedimentation rate, ESR）<21 mm/h、C反应蛋白（C-reactive protein, CRP）<11 mg/L，对应的受试者工作特征曲线下面积（area under the curve, AUC）分别为0.91（灵敏度90%，特异度85%）与0.88（灵敏度95%，特异度80%）。本研究证实了脉冲治疗在非特异性主动脉炎各分期中的有效性，具体验证了两项核心结论：1）炎症反应持续存在且慢性期分期具有相对性；2）未先行脉冲治疗即开展手术治疗存在不良影响——在保守治疗场景下，辅以脉冲治疗可使非特异性主动脉炎的病情进展发生率从26.3%降至6.1%，降幅达4.3倍；在手术治疗场景下，病情进展发生率从49.4%降至13.1%，降幅达3.8倍。所有非特异性主动脉炎患者的标准化治疗策略为采用环磷酰胺（cyclophosphane）与甲泼尼龙（methylprednisolone）联合脉冲治疗，该方案适用于慢性期患者、存在手术指征的患者，以及急性期与亚急性期患者。该治疗策略可有效稳定炎症反应、控制病情进展并预防并发症发生。