剪切波弹性成像在以发热和颈部淋巴结增大为首发症状川崎病中的初步研究

Preliminary study of shear wave elastography in lymph-node-first presentation of Kawasaki disease

目的应用实时剪切波弹性成像(SWE)评估颈部淋巴结弹性,探讨SWE检查在以发热和颈部淋巴结增大为首发症状的川崎病(NFKD)患儿中的临床价值。方法选取以发热和颈部淋巴结增大为首发症状就诊的患儿88例,收集其实验室检查指标、颈部常规超声特征及SWE测值。根据临床确诊结果分为川崎病47例(NFKD组),细菌性淋巴结炎41例(BCL组);另选取同期41例健康儿童作为对照组。比较各组间实验室检查指标、常规超声特征、最大杨氏模量值(Emax)及平均杨氏模量值(Emean)的差异,分析实验室检查指标与Emean的相关性。结果除中性粒细胞计数外,各组实验室检查指标比较差异均有统计学意义(均P<0.05)。BCL组颈部最大淋巴结长径、短径、Emax及Emean均高于NFKD组和对照组,NFKD组颈部最大淋巴结长径、短径、Emax及Emean均高于对照组,三组间比较差异均有统计学意义(均P<0.05)。NFKD组颈部淋巴结回声均匀,呈串珠样改变,多位于左侧颈部ⅡA区;BCL组颈部淋巴结多呈孤立性肿大,内回声不均匀。相关性分析结果表明,血沉、降钙素原、白细胞计数、谷丙转氨酶(ALT)与BCL组Emean均呈正相关(r=0.465、0.658、0.450、0.322,均P<0.05);C反应蛋白、白介素6、谷丙转氨酶、谷草转氨酶与NFKD组Emean均呈正相关(r=0.388、0.439、0.686、0.521,均P<0.05)。结论应用SWE测量颈部淋巴结弹性可为临床早期鉴别NKFD和BCL提供影像学参考依据。

Objective To assess the elasticity of cervical lymph nodes by real-time shear wave elastography(SWE),and to explore its clinical value for diagnosis of children with SWE in lymph-node-first presentation of Kawasaki disease(NFKD).Methods A total of 88 children with fever and cervical lymph nodes enlargement as the first symptoms were selected to collect baseline data,laboratory data,cervical conventional ultrasound characteristics and SWE measurements.According to the clinical diagnosis results,they were divided into 47 cases of Kawasaki disease(NFKD group),41 cases of bacterial lymphadenitis(BCL group),and 41 healthy children in the same period were selected as the control group(HC group).The laboratory data,conventional ultrasound characteristics,tmax and Emean were compared among the three groups,the correlation between laboratory data and Emean were analyzed.Results Except for neutrophil counts,the differences in laboratory test parameters of each group were statistically significant(all P<0.05).The size and Emean of the largest cervical lymph nodes in BCL group were higher than those in NFKD group and HC group.The size and Emean of the largest cervical lymph node in NFKD group were higher than those in HC group.The differences among the three groups were statistically significant(all P<0.05).The cervical lymph nodes in the NFKD group had even echoes,which were mostly located in theⅡA area of left neck,and the distribution was mostly bead-like changes.The neck lymph nodes in the BCL group showed solitary enlargement and uneven internal echo.Erythrocyte sedimentation rate,Procalcitonin,White blood cell,alanine aminotransferase were positively correlated with Emean of BCL group(r=0.465,0.658,0.450,0.322,all P<0.05),Interleukin-6,alanine aminotransferase,aspartate transaminase were positively correlated with Emean of NFKD group(r=0.388,0.439,0.686,0.521,all P<0.05).Conclusion Cervical lymph node elasticity measured by SWE can provide imaging reference for early identification of NKFD and BCL in clinic.