CT淋巴管成像在不同类型蛋白丢失性肠病中的影像特征比较研究

Comparison of Imaging Features with CT Lymphangiography CT in Different Type of Protein Losing Enteropathy:A Retrospective Study

目的探讨CT淋巴管成像(CTL)在不同类型蛋白丢失性肠病(PLE)中的影像特征和比较的应用价值研究。方法回顾性搜集和分析不同病因导致的PLE患者57例,包括原发性小肠淋巴管扩张症(PIL)组42例和其他类型的PLE组15例。所有患者均行CTL、内镜与病理学检查,由两名放射科医师盲法分析CTL图像。评价内容包括:小肠肠壁增厚,肠腔扩张,水肿样病变,对比剂异常分布的部位及范围,返流,腹腔淋巴结,瘘等。将两组患者的临床和影像学特征进行比较和统计学分析,取P<0.05为差异有统计学意义。结果与其他类型PLE组相比,PIL组患者的首次发病年龄更小[(14.7±10.6)岁vs.(38.8±10.7)岁,P<0.01],累及多组小肠、多个脏器、多个系统的比例更高,且该组患者小肠肠壁与肠系膜对比剂异常分布及淋巴返流的比例明显高于其他类型PLE(P<0.01)。两组间肠壁增厚、肠管扩张、水肿样表现、瘘、腹腔内淋巴结无明显差异(P>0.05)。结论CTL在不同类型PLE中具有不同的影像表现,可显示异常淋巴管的部位、分布和范围,准确评价异常淋巴管有助于治疗方式的合理选择。

Objective To compare the imaging features of CT lymphangiography(CTL)in different type protein losing enteropathy(PLE).Methods Fifty-seven Patients diagnosed as PLE were recruited in this retrospective study,and they were divided into two groups,including 42 patients with primary intestinal lymphangiectasia(PIL)and 15 patients with other kinds of PLE.All patients underwent CTL,endoscopy and pathological examinations.All the imaging data were blinded reviewed by two radiologists respectively,with the imaging features of intestinal wall thickening,dilation of intestinal lumen,edematous lesions,abnormal distribution of contrast agents,reflux,lymph nodes and fistula.Imaging features comparisons were performed between the two groups,and statistical analyses were performed with P<0.05.Results Compared with other kinds of PLE,patients with PIL demonstrated lower onset age(14.7±10.6 Vs.38.8±10.7,P<0.01).For imaging features,the proportion of abnormal distribution of contrast media in intestinal wall and mesentery and lymph reflux are higher in PIL than other PLE.While no statistical difference was found in intestinal wall dilatation,edematous lesions,abnormal distribution of contrast media in other abdominal cavity,fistula and lymph node(all P>0.05).Conclusion CTL demonstrates different imaging features in PIL and other PLE,capability in detection of location,distribution and range of abnormal lymphatics,which is useful for differential diagnosis and therapeutic adoptions for PLE.