自身免疫性肝病患者腹部淋巴结肿大的临床及影像学特征分析  

Clinical and imaging analysis of abdominal lymph node enlargement in patients with autoimmune liver disease

作　　者：尹全乐 张红霞[2] 陈旭[2] 周璐[2] 王颖[3] Yin Quan-Le;Zhang Hong-Xia;Chen Xu;Zhou Lu;Wang Ying(Department of Radiology,Tianjin Port Hospital,Tianjin 300456,China;Department of Gastroenterology,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Radiology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津港口医院放射科,天津300456 [2]天津医科大学总医院消化科,天津300052 [3]天津医科大学总医院放射科,天津300052

出　　处：《解放军医学杂志》2023年第10期1201-1207,共7页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(81860109,81470834)。

摘　　要：目的探讨CT评估自身免疫性肝病(AILD)患者腹部淋巴结肿大的临床价值。方法选取2015年1月-2019年12月在天津医科大学总医院就诊的136例AILD患者(设为AILD组),并以65例其他慢性肝病患者作为对照组。回顾性分析两组患者的腹部CT资料,统计腹部不同区域淋巴结的体积及数目分布,应用受试者工作特征曲线下面积(AUROC)评估腹部淋巴结肿大对AILD的诊断价值,并采用logistic回归分析肝周淋巴结肿大的危险因素。结果AILD组腹部淋巴结的平均体积[(0.47±0.61)cm^(3)vs.(0.25±0.20)cm^(3)]及数目[(8.10±4.97)个vs.(4.26±3.25)个]均较对照组增大或增加(P<0.001)。肝周淋巴结数目联合肠系膜淋巴结体积诊断AILD的AUROC为0.816(P<0.001)。77例行肝组织活检的AILD患者中,肝周淋巴结阳性组肝组织中界面性肝炎的发生率高于肝周淋巴结阴性组(52.31%vs.16.67%,χ^(2)=5.169,P<0.05)。多因素logistic回归分析显示,血清IgG抗体水平增高是肝周淋巴结肿大的独立危险因素(OR=1.012,95%CI 1.000~1.024,P<0.05)。结论肝周及肠系膜淋巴结肿大有助于AILD的鉴别诊断,肝周淋巴结肿大与AILD肝炎性活跃度相关。Objective To evaluate the clinical value to characterize abdominal lymphadenopathy in autoimmune liver diseases(AILD)patients using computed tomography(CT).Methods We recruited 136 AILD patients(set as AILD group)from January 2015 to December 2019 and 65 patients with other liver diseases(set as control group).We assessed the volume and number of the enlarged lymph nodes in different lymph centers using CT.To evaluate the diagnosis value of abdominal lymphadenopathy for AILD,we calculated the area under the receiver operating characteristic curve(AUROC)of abdominal lymphadenopathy.We further employed logistic regression to analyze the risk factors associated with perihepatic lymph node enlargement.Results The abdominal lymph nodes in AILD group had significantly increased average volume and number than those in control group[(0.47±0.61)cm^(3) vs.(0.25±0.20)cm^(3);8.10±4.97 vs.4.26±3.25,P<0.001].The combination of the number of hepatic lymph nodes and the volume of mesenteric lymph nodes showed well diagnostic value for AILD(AUROC=0.816,P<0.001).Within 77 AILD patients,who underwent liver biopsy,patients with positive hepatic lymphadenopathy showed a significantly higher proportion of interface hepatitis in liver tissues than patients with negative hepatic lymphadenopathy(52.31%vs.16.67%,χ^(2)=5.169,P<0.05).Multivariate analysis showed that the serum IgG level is a risk factor for perihepatic lymph node enlargement(OR=1.012,95%CI 1.000-1.024,P<0.05).Conclusions The enlargement of hepatic and mesenteric lymph nodes is of value in the differential diagnosis of AILD.Enlargement of hepatic lymph nodes is correlated with the disease activity in AILD.

关 键 词：自身免疫性肝病 腹部淋巴结 疾病活动性 计算机断层扫描 

分 类 号：R575[医药卫生—消化系统]