Buerger 病患者通常在多年内出现反复发作的急性缺血。此疾病于 30-40 岁间加剧,然后开始消退。在>60 岁患者中少见。[55]Szuba A, Cooke JP. Thromboangiitis obliterans: an update on Buerger's disease. West J Med. 1998;168:255-260.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1304949/pdf/westjmed00331-0029.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/9584663?tool=bestpractice.com
戒烟
继续吸烟的患者截肢率高达 19%;[29]Ohta T, Ishioashi H, Hosaka M, et al. Clinical and social consequences of Buerger disease. J Vasc Surg. 2004;39:176-180.http://www.ncbi.nlm.nih.gov/pubmed/14718836?tool=bestpractice.com此数字被认为是戒烟患者的 2.73 倍。[49]Sasaki S, Sakuma M, Yasuda K. Current status of thromboangiitis obliterans (Buerger's disease) in Japan. Int J Cardiol. 2000;75(suppl 1):S175-S181.http://www.ncbi.nlm.nih.gov/pubmed/10980360?tool=bestpractice.com吸烟可增加疾病的复燃率并且减慢溃疡愈合。戒烟后复吸可引起疾病复燃。每日吸 1 或 2 支香烟,使用无烟烟草(咀嚼烟草)制成的香烟或使用尼古丁替代疗法均可使疾病保持活动性。[17]Lie JT. Thromboangiitis obliterans (Buerger's disease) and smokeless tobacco. Arthritis Rheum. 1988;31:812-813.http://www.ncbi.nlm.nih.gov/pubmed/3382454?tool=bestpractice.com[18]Joyce JW. Buerger's disease (thromboangiitis obliterans). Rheum Dis Clin North Am. 1990;16:463-470.http://www.ncbi.nlm.nih.gov/pubmed/2189162?tool=bestpractice.com尽管伐尼克兰对戒烟有效,但患者最好通过戒烟课程进行戒烟。伐尼克兰是一种选择性烟碱受体部分激动剂,可用来辅助戒烟。
截肢术
确诊后 5 年内,25% 的患者会接受截肢术。确诊 10 年后,患者的截肢率可升高至 38%。[56]Cooper LT, Tse TS, Mikhail MA, et al. Long-term survival and amputation risk in thromboangiitis obliterans (Buerger's disease). J Am Coll Cardiol. 2004;44:2410-2411.http://www.ncbi.nlm.nih.gov/pubmed/15607407?tool=bestpractice.com患者通常需反复接受截肢术治疗,这表明了该疾病的严重性。
[Figure caption and citation for the preceding image starts]: 多重截肢术由 Matthew J. Metcalfe 和 Alun H. Davies 提供 [Citation ends].
预期寿命
Buerger 病不会改变患者的预期寿命:其中 90%-95% 的患者可继续存活 10 年;[57]Ates A, Yekeler I, Ceviz M, et al. One of the most frequent vascular diseases in northeastern of Turkey: thromboangiitis obliterans or Buerger's disease (experience with 344 cases). Int J Cardiol. 2006;111:147-153.http://www.ncbi.nlm.nih.gov/pubmed/16580754?tool=bestpractice.com[1]Mills JL, Porter JM. Buerger's disease (thromboangiitis obliterans). Ann Vasc Surg. 1991;5:570-572.http://www.ncbi.nlm.nih.gov/pubmed/1772769?tool=bestpractice.com85% 的患者可继续存活 25 年。[29]Ohta T, Ishioashi H, Hosaka M, et al. Clinical and social consequences of Buerger disease. J Vasc Surg. 2004;39:176-180.http://www.ncbi.nlm.nih.gov/pubmed/14718836?tool=bestpractice.com这可能是因为除了吸烟之外,Buerger 病与心血管危险因素并无关联。