超声检查RA病人引流淋巴结发现亚临床重构的临床意义

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Rheumatology (Oxford). 2011 Aug;50(8):1395-400. Epub 2011 Mar 4.   Subclinical remodelling of draining lymph node structure in early and established rheumatoid arthritis assessed by power Doppler ultrasonography.   Manzo A, Caporali R, Vitolo B, Alessi S, Benaglio F, Todoerti M, Bugatti S, Calliada F, Montecucco C.   Source Division of Rheumatology, Laboratory of Rheumatology, University of Pavia School of Medicine and IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy. montecucco@smatteo.pv.it.   Abstract Objective. To investigate the suitability of power Doppler ultrasonography (PD-US) for the assessment of lymph node (LN) status in RA, evaluating the existence of structural and dynamic modifications in well-characterized stages of the disease. Methods. Ten patients with active disease and five patients in clinical remission underwent complete clinical and PD-US examination of hands, wrists, axillary and cervical LNs on the same day. Synovitis and PD were graded 0-3. LN assessment included maximum short axis, cortical hypertrophy (CH) and PD signal distribution. All patients with active disease were re-evaluated prospectively 3 months after initiation of therapy. Results. PD-US signs of axillary LN remodelling were observed in 7 out of 10 patients with active disease despite the absence of clinical lymphoadenopathy. Subclinical alterations were detected in both early untreated RA and in established disease. Characteristic structural changes consisted of hypertrophy of the LN cortex and PD signal amplification in cortical and hilar regions. Cervical LNs in active disease and axillary LNs in clinical remission were unaffected. LN PD amplification returned to normal ranges in patients with baseline alterations re-evaluated 3 months after therapy with TNF-α blocking agents and/or MTX. Conclusion. Draining LNs in RA are subjected to subclinical intra-parenchymal changes and vascular flow modulation detectable by PD-US. Sonographic signs of LN involvement associate with disease activity and are reversible upon treatment. These data point at LN reactivity as a dynamic component of RA inflammatory cascade and an attractive platform to be explored in prognostic and response to therapy evaluations.   PMID:  21378108

超声检查RA病人引流淋巴结发现亚临床重构的临床意义   Manzo A, et al. Rheumatol(Oxford). 2011;50: 1395-400.   目的: 探讨能量多普勒超声(PDUS)对于评估RA病人淋巴结(LN)状态的实用性，对于已熟知特征的不同阶段疾病是否存在淋巴结结构性、动态性变化进行评估。 方法：10例活动性病人以及5例临床缓解病人在同一天接受完整的临床以及PDUS检查，包括手、腕、腋窝以及颈部。滑膜和PD采用半定量法评估(0 - 3)。LN评估包括最大短轴、皮质肥大(CH)和PD信号分布。对所有病情活动患者进行前瞻性随访，即在接受初始治疗3个月后进行再评估。 结果：10例活动性病人中，有7例查见腋窝淋巴结的PDUS征像，而临床未见淋巴结肿大。未经治疗的早期病人以及长病程病人中均可见亚临床改变。特征性结构变化有淋巴结皮质增厚，皮质和门部PD信号增强。活动性患者颈部淋巴结以及临床缓解患者腋窝淋巴结不受影响。接受TNF拮抗剂和/或MTX治疗3个月后，淋巴结PD信号由基线时的增强回落至正常。 结论：RA病人引流淋巴结易受亚临床的实质内部变化血管及血管流变的影响，PDUS可检测后者。疾病相关淋巴结的超声征像与疾病活动度相关，经治疗后可逆转。这些数据提示淋巴结活动性是RA炎症级联反应的一个动态组成，这个令人感兴趣的领域有待进一步研究其是否在预后和治疗反应中有应用价值。