肠系膜脂膜炎12例临床特征分析

An analysis of clinical characteristics of twelve cases of mesenteric panniculitis

目的肠系膜脂膜炎是一种少见的肠系膜脂肪组织慢性非特异性炎性疾病，目前对其病因、诊断和治疗方法了解较少，本研究拟总结该病特点以提高临床的认识。方法回顾性分析北京协和医院12例肠系膜脂膜炎的临床表现、诊断、治疗和转归。结果12例患者男女比例为3∶1，中位诊断年龄58岁。最常见的症状为腹痛（9/12），其次为腹胀（3/12）、体重下降（3/12）。多数患者（8/12）腹部无异常体征。多数患者C反应蛋白（9/12）和ESR（10/12）正常。CT检查有重要诊断价值，CT显示所有患者均有小肠系膜受累（12/12），呈多发结节样改变，脂肪密度增高，8例有假包膜征，6例有脂肪环征。4例患者获得病理诊断，示脂肪组织坏死伴炎性细胞浸润及纤维组织增生。6例患者接受糖皮质激素治疗，2例接受环磷酰胺、1例接受硫唑嘌呤、1例接受雷公藤治疗，短期内症状均有缓解，但有2例（2/12）病情复发。结论肠系膜脂膜炎多见于中老年人，常以腹痛为首发表现，其炎症指标大多正常，CT是最重要的诊断方法。手术联合糖皮质激素和免疫抑制剂治疗有效。

ObjectiveMesenteric panniculitis is an idiopathic, uncommon disease involving the adipose tissue of mesentery. The etiology, diagnosis and treatment are still unnoticed. We thus reported a case series to improve the understanding of this rare disorder.MethodsWe retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation, diagnosis, treatment and prognosis.ResultsWe found a male predominance （M∶F 3∶1） with the median age of 58 years old at diagnosis. The most common symptom was abdominal pain （9/12）, followed by abdominal distension （3/12） and weight loss （3/12）. Physical examination was unremarkable in the majority of patients （8/12）. C reactive protein （9/12） and erythrocyte sedimentation rate （10/12） were normal in majority of patients. CT findings were of much diagnostic value. All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density. Pseudo-capsule sign （8/12） and fat halo sign （6/12） were common. Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis. Six cases all received prednisone, 2 with combined cyclophosphamide, 1 with azathioprine, 1 with tripterygium wilfordii. Short-term clinical response was achieved in all cases, but two patients relapsed.ConclusionsMesenteric panniculitis occurs predominantly in middle-aged and elderly. Abdominal pain is the leading symptom. Inflammatory markers are often normal while computed tomography is the most important diagnostic tool. Surgery combined with cortical steroid and immunosuppressant agents is effective.