PET-CT诊断以发热待查为表现的早期大动脉炎的临床价值研究

doi:10.12114/j.issn.1007-9572.2021.01.048

摘要/Abstract

摘要： 背景以发热待查（FUO）为表现的大动脉炎（TAK）临床并不多见，由于早期患者临床症状和体征无特异性，且缺乏大动脉狭窄和闭塞的影像学表现，这使得早期诊断非常困难。随着正电子发射计算机断层显像/计算机断层扫描技术（PET-CT）在FUO诊断和鉴别诊断中的广泛应用，其可能有助于早期TAK的诊断。目的探讨PET-CT在以FUO为表现的早期TAK诊断和病情评估中的应用价值。方法回顾性分析2013年1月至2021年1月就诊于苏州大学附属第一医院风湿免疫科以FUO为表现而最终通过PET-CT确诊为TAK的7例患者的临床资料，包括临床表现、实验室检查、影像学检查及治疗转归等，并对临床资料进行总结及对近30年来的相关文献进行复习。结果7例患者均为女性，发病年龄27~58岁，平均年龄（37.9±10.6）岁；病程1~6个月，平均（3.9±2.4）个月。患者均以发热待查为表现，可伴有心悸（14.3%）、头晕（28.6%）、头痛（14.3%）、乏力（28.6%）等非特异性临床症状；实验室检查可见血白细胞计数（71.4%）、血小板计数（57.1%）、红细胞沉降率（ESR）（100.0%）、C反应蛋白（CRP）（85.7%）、肿瘤坏死因子α（TNF-α）（42.9%）和白介素6（IL-6）（85.7%）升高。血管彩色多普勒超声、计算机断层血管造影（CTA）和磁共振血管造影（MRA）未见大动脉狭窄和闭塞，而PET-CT可见多部位动脉管壁炎症性改变，包括升主动脉（28.6%）、主动脉弓（14.3%）、颈总动脉（28.6%）、锁骨下动脉（28.6%）、胸主动脉（14.3%）、腹主动脉（14.3%）、肾动脉（14.3%）等大动脉。结论PET-CT有助于以FUO为表现，而无大动脉狭窄和闭塞的早期TAK的诊断和病情评估。

关键词: 动脉炎, 大动脉炎, 原因不明发热, 体层摄影术, X线计算机, 诊断

Abstract: Background

Takayasu's arteritis (TAK) presenting as fever of unknown origin (FUO) is rare in clinic. Diagnosis is difficult in the early stageas the non-specific clinical symptoms and signs, the lack of imaging findings of great artery stenosis and occlusionof patients. With the wide application of positron emission computed tomography/computed tomography (PET-CT) in the diagnosis and differential diagnosis of FUO, it may contribute to the early diagnosis of TAK.

Objective

To investigate the application value of PET-CT in the diagnosis and condition assessment of early TAK presenting as FUO.

Methods

The clinical presentations, laboratory examinations, PET-CT findings, and treatment outcomes of 7 cases of TAK presenting as FUO that eventually diagnosed by PET-CT from January 2013 to January 2021were retrospectively analyzed, and the medical literature from 1991 to 2021 was reviewed.

Results

All the 7 patients were female, the age of onsetranging from 27 to 58 years old, with an average age of (37.9±10.6) years. The course of disease was from 1 to 6 months, with an average of (3.9±2.4) months. FUO was the first symptom of all patients (100.0%) , which may be accompanied by palpitation (14.3%) , dizziness (28.6%) , headache (14.3%) , fatigue (28.6%) and other non-specific clinical symptoms. Laboratory tests showed elevated levels of leukocytes (71.4%) , platelets (57.1%) , erythrocyte sedimentation rate (ESR) (100.0%) , C-reactive protein (CRP) (85.7%) , tumor necrosis factor-α (TNF-α) (42.9%) and interleukin-6 (IL-6) (85.7%) . Color Doppler ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) showed no stenosis and occlusion of large arteries, while PET-CT showed inflammatory changes in arterial walls at multiple locations, including thecending aorta (28.6%) , aortic arch (14.3%) , common carotid artery (28.6%) , subclavian artery (28.6%) , thoracic aorta (14.3%) , abdominal aorta (14.3%) and renal artery (14.3%) .

Conclusion

PET-CT is helpful in the diagnosis and condition assessment of pre-pulseless Takayasu's arteritis presenting as FUO.

Key words: Arteritis, Takayasu's arteritis, Fever of unknown origin, Tomography, X-Ray computed, Diagnosis

中图分类号:

R543.5

曾克勤,尹玉峰,任田,等. PET-CT诊断以发热待查为表现的早期大动脉炎的临床价值研究[J]. 中国全科医学, 2022, 25(08): 918-923. DOI: 10.12114/j.issn.1007-9572.2021.01.048.

ZENG Keqin, YIN Yufeng, REN Tian, ZHOU Erye, WANG Mingjun, WU Jian.

The Clinical Value of PET-CT in the Diagnosis of Pre-pulseless Takayasu's Arteritis Presenting as Fever of Unknown Origine [J]. Chinese General Practice, 2022, 25(08): 918-923.

图/表 2

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