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

The Clinical Value of PET-CT in the Diagnosis of Pre-pulseless Takayasu's Arteritis Presenting as Fever of Unknown Origine

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。

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.