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多发性大动脉炎(Takayasu arteritis,TA)是累及主动脉及其主要分支的慢性、进展性、非特异性、肉芽肿性大血管炎,少数累及肺动脉、冠状动脉,是儿童大血管炎最常见的类型。目前,国内儿童TA的报道较少见,病理早期血管外膜大量炎症细胞浸润和纤维化并逐渐累及全层,进而导致管壁增厚、僵硬、顺应性下降,管腔狭窄、闭塞、瘤样扩张甚至出现夹层[1]。儿童TA较为罕见、起病隐匿、异质性大,因此诊断难度大。TA的诊断主要基于临床症状、体征、实验室检查指标和影像特征,主动脉CT血管成像(CT angiography,CTA)在显示血管受累范围、程度和管壁、管腔情况中具有很大优势。本研究收集11例TA患儿的影像资料,分析、归纳其影像特点,以提高临床医师对该病的筛查率、诊断准确率,使患儿得到及时、有效的治疗。
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由表1可知,9例(81.8%)TA患儿为活动期;5例(45.5%)伴全身症状;10例(90.9%)并发高血压;6例(54.5%)伴血管症状;4例(36.4%)伴心脏症状,均有心功能不全和心脏瓣膜返流其中1例有扩张性心肌病;3例(27.3%)伴中枢神经系统症状,其中1例并发高血压脑病(9.1%)(图1)。CRP升高、血红蛋白减低各5例(45.5%),ESR、WBC和血小板计数升高各4例(36.4%)。
项目 例数(%) 统计值( )$ \bar x \pm s $ 活动期 9(81.8) − 全身症状(发热、乏力、食欲不振、肌肉痛、关节痛、体重减轻、皮疹等) 5(45.5) − 高血压 10(90.9) − 中枢神经系统症状(癫痫、晕厥、头晕) 3(27.3) − 血管症状[血管杂音、动脉搏动减弱和(或)消失、肢体血压差] 6(54.5) − 心脏症状(心功能不全、扩张性心肌病、心脏瓣膜反流) 4(36.4) − 胸痛 1(9.1) − ESR 4(36.4) (27.55±24.45) mm/h CRP 5(45.5) (24.14±47.20) mg/L WBC 4(36.4) (7.84±3.04)×109 个/L RBC 0 (4.45±0.40)×1012 个/L Hb 5(45.5) (113.09±19.34) g/L PLT 4(36.4) (339.73±110.13)×109 个/L 注:−表示无此项数据。ESR为红细胞沉降率(正常值为0~20.00 mm/h);CRP为C反应蛋白(正常值为0~8.00 mg/L);WBC为白细胞计数(正常值为3.50×109~9.50×109个/L);RBC为红细胞计数(正常值为女患儿4.30×1012~5.00×1012个/L、男患儿0~5.50×1012个/L);Hb为血红蛋白(正常值为110.00~160.00 g/L);PLT为血小板计数(正常值为100.00×109~300.00×109个/L) 表 1 11例多发性大动脉炎患儿的临床资料和实验室检查结果
Table 1. Clinical data and laboratory examination results of 11 children with Takayasu arteritis
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由表2可知,Numano分型最常见的为Ⅳ、Ⅴ型,共10例(90.9%),11例(100%)降主动脉受累,10例(90.9%)肾动脉受累,5例(45.5%)主动脉弓及其分支受累,2例(18.2%)肺动脉受累。11例(100%)TA患儿CT平扫管壁密度均增高,呈高密度环征(图2A)。9例(81.8%)活动期患儿有血管周围脂肪组织浑浊,3例(27.3%)管壁钙化(图2B)。11例(100%)TA患儿的CTA中主动脉及其分支均有弥漫性、多节段受累,管壁均增厚(3.1±0.9)mm并伴有不均匀强化(图2C),8例(72.7%)壁内层呈低密度环征(图2D)。主动脉分支中肾动脉受累导致的肾动脉狭窄发生率最高(图2E),2例(18.3%)肺动脉受累管腔均狭窄和(或)闭塞(图2F、2G),4例(36.4%)主动脉扩张(图2H)。
项目 例数(%) 统计值( )$ \bar x \pm s $ Numano分型 Ⅰ 0 − Ⅱ 0 − Ⅲ 1(9.1) − Ⅳ 5(45.5) − Ⅴ 5(45.5) − 降主动脉受累 11(100) − 主动弓及其分支受累 5(45.5) − 肾动脉受累 10(90.9) − 肺动脉受累 2(18.2) − 管壁钙化 3(27.3) − 高密度环征 11(100) − 管壁增厚 11(100) (3.1±0.9) mm 管壁不均匀强化 11(100) − 低密度环征 8(72.7) − 主动脉管腔狭窄 10(90.9) (62±29)% 分支管腔狭窄 11(100) (87±21)% 主动脉正性重塑 2(18.2) − 分支正性重塑 1(9.1) − 主动脉扩张 4(36.4) (123±40)% 分支扩张 0 − 血管周围脂肪组织浑浊 9(81.8) − 注:−表示无此项数据。TA为多发性大动脉炎;CT为计算机体层摄影术 表 2 11例TA患儿的CT影像特征及其测量结果
Table 2. CT imaging characteristics and measurement results of 11 children with Takayasu arteritis
儿童多发性大动脉炎主动脉CT血管成像的影像特征
CT angiography features of Takayasu arteritis in children
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摘要:
目的 探讨儿童多发性大动脉炎(TA)主动脉CT血管成像(CTA)的影像特征及临床价值。 方法 回顾性分析2016年1月至2022年9月新疆维吾尔自治区人民医院收治的11例TA患儿的临床资料、影像资料及实验室检查结果。男患儿1例、女患儿10例(青春期女童8例),年龄(14.3±3.7)岁,病程(24.3±37.9)个月。所有患儿均行胸腹部CT平扫、主动脉CTA及其后处理检查,包括多平面重建、最大密度投影、容积再现和曲面重建。分析儿童TA的影像特征,判断Numano分型,观察主动脉及其分支、肺动脉受累的范围和程度,管壁(增厚、钙化、高密度环征、低密度环征、不均匀强化)、管腔(狭窄、扩张、正性重塑)及血管周围脂肪组织情况。 结果 11例TA患儿中,活动期9例(81.8%,9/11),并发高血压10例(90.9%,10/11),伴发全身症状5例(45.5%,5/11),伴心脏症状4例(36.4%,4/11),伴中枢神经系统症状3例(27.3%,3/11),其中1例并发高血压脑病(9.1%,1/11)。C反应蛋白升高、血红蛋白减低各5例(45.5%,5/11),红细胞沉降率、白细胞计数和血小板计数升高各4例(36.4%,4/11)。Numano分型最常见的为Ⅳ、Ⅴ型,共10例(90.9%,10/11),降主动脉受累11例(100%,11/11),肾动脉受累10例(90.9%,10/11),主动脉弓及其分支受累5例(45.5%,5/11),肺动脉受累2例(18.2%,2/11)。11例(100%,11/11)TA患儿CT平扫管壁密度均增高,呈高密度环征。9例(81.8%,9/11)活动期患儿有血管周围脂肪组织浑浊,3例(27.3%,3/11)管壁钙化。11例患儿CTA中主动脉及其分支均有弥漫性、多节段受累,管壁均增厚(3.1±0.9) mm并伴有不均匀强化。8例(72.7%,8/11)壁内层呈低密度环征。主动脉分支中肾动脉狭窄发生率最高(90.9%,10/11),2例(18.3%,2/11)肺动脉受累管腔均狭窄和(或)闭塞,4例主动脉扩张(36.4%,4/11)。 结论 主动脉CTA可清晰显示主动脉及其分支、肺动脉,全面显示受累血管的情况。分析儿童TA的CTA影像特征,对该病的筛查、诊断及评估具有重要意义。 -
关键词:
- Takayasu动脉炎 /
- 儿童 /
- 主动脉 /
- 体层摄影术,X线计算机
Abstract:Objective To explore the imaging characteristics and clinical value of CT angiography (CTA) of the aorta in children with Takayasu arteritis (TA). Method We conducted a retrospective analysis of clinical data, imaging data, and laboratory examination results of 11 children with TA admitted to People’s Hospital of Xinjiang Uygur Autonomous Region from January 2016 to September 2022. The patients comprised 1 male and 10 females (8 adolescent girls). The age was (14.3±3.7) years. The course of the disease was (24.3±37.9) months. All children underwent chest and abdominal CT plain scan, aortic CTA, and post-processing examination, including multi-plane reconstruction, maximum density projection, volume reconstruction, and surface reconstruction. The imaging features of pediatric TA were analyzed, and the Numano classification was determined. Moreover, we observed the extent and degree of involvement of the aorta, branches, and pulmonary arteries, as well as the wall (thickening, calcification, high-density ring sign, low-density ring sign, and uneven enhancement), lumen (stenosis, dilation, and positive remodeling), and perivascular adipose tissue. Result Among the 11 children with TA, 9 were in the active phase (81.8%, 9/11), 10 were complicated with hypertension (90.9%, 10/11), 5 were accompanied with systemic symptoms (45.5%, 5/11), 4 were accompanied with cardiac symptoms (36.4%, 4/11), and 3 were accompanied with central nervous system symptoms (27.3%, 3/11), of which 1 case was complicated with hypertensive encephalopathy (9.1%, 1/11). There were 5 cases of elevated C-reactive protein and 5 cases of decreased hemoglobin (45.5%, 5/11), and there were 4 cases of elevated red blood cell sedimentation rate, white blood cell count, and platelet count (36.4%, 4/11). The most common types of Numano classification were IV and V, with a total of 10 cases (90.9%, 10/11); 11 cases (100%, 11/11) involved the descending aorta, 10 cases (90.9%, 10/11) involved the renal artery, 5 cases (45.5%, 5/11) involved the aortic arch and its branches, and 2 cases (18.2%, 2/11) involved the pulmonary artery. All 11 cases (100%, 11/11) of TA children showed increased wall density on CT plain scan, presenting as a high-density ring sign, and 3 cases (27.3%, 3/11) had wall calcification. Nine cases (81.8%, 9/11) of active children had perivascular adipose tissue opacity. In all 11 cases of CTA, the aorta and its branches were diffusely and multi-segmentally involved, with thickening of the wall (3.1±0.9) mm and uneven enhancement. Eight cases (72.7%, 8/11) showed a low-density ring sign in the inner wall. Renal artery stenosis in the aortic branches had the highest incidence (90.9%, 10/11), with 2 cases (18.3%, 2/11) of pulmonary artery involvement with stenosis and/or occlusion of the lumen and 4 cases of aortic dilation (36.4%, 4/11). Conclusions Aortic CTA can clearly display the aorta and its branches and pulmonary arteries. It can also comprehensively display the situation of affected blood vessels. Analyzing the CTA imaging features of children with TA is of great significance for the screening, diagnosis, and evaluation of the disease. -
Key words:
- Takayasu arteritis /
- Child /
- Aorta /
- Tomography, X-ray computed
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表 1 11例多发性大动脉炎患儿的临床资料和实验室检查结果
Table 1. Clinical data and laboratory examination results of 11 children with Takayasu arteritis
项目 例数(%) 统计值( )$ \bar x \pm s $ 活动期 9(81.8) − 全身症状(发热、乏力、食欲不振、肌肉痛、关节痛、体重减轻、皮疹等) 5(45.5) − 高血压 10(90.9) − 中枢神经系统症状(癫痫、晕厥、头晕) 3(27.3) − 血管症状[血管杂音、动脉搏动减弱和(或)消失、肢体血压差] 6(54.5) − 心脏症状(心功能不全、扩张性心肌病、心脏瓣膜反流) 4(36.4) − 胸痛 1(9.1) − ESR 4(36.4) (27.55±24.45) mm/h CRP 5(45.5) (24.14±47.20) mg/L WBC 4(36.4) (7.84±3.04)×109 个/L RBC 0 (4.45±0.40)×1012 个/L Hb 5(45.5) (113.09±19.34) g/L PLT 4(36.4) (339.73±110.13)×109 个/L 注:−表示无此项数据。ESR为红细胞沉降率(正常值为0~20.00 mm/h);CRP为C反应蛋白(正常值为0~8.00 mg/L);WBC为白细胞计数(正常值为3.50×109~9.50×109个/L);RBC为红细胞计数(正常值为女患儿4.30×1012~5.00×1012个/L、男患儿0~5.50×1012个/L);Hb为血红蛋白(正常值为110.00~160.00 g/L);PLT为血小板计数(正常值为100.00×109~300.00×109个/L) 表 2 11例TA患儿的CT影像特征及其测量结果
Table 2. CT imaging characteristics and measurement results of 11 children with Takayasu arteritis
项目 例数(%) 统计值( )$ \bar x \pm s $ Numano分型 Ⅰ 0 − Ⅱ 0 − Ⅲ 1(9.1) − Ⅳ 5(45.5) − Ⅴ 5(45.5) − 降主动脉受累 11(100) − 主动弓及其分支受累 5(45.5) − 肾动脉受累 10(90.9) − 肺动脉受累 2(18.2) − 管壁钙化 3(27.3) − 高密度环征 11(100) − 管壁增厚 11(100) (3.1±0.9) mm 管壁不均匀强化 11(100) − 低密度环征 8(72.7) − 主动脉管腔狭窄 10(90.9) (62±29)% 分支管腔狭窄 11(100) (87±21)% 主动脉正性重塑 2(18.2) − 分支正性重塑 1(9.1) − 主动脉扩张 4(36.4) (123±40)% 分支扩张 0 − 血管周围脂肪组织浑浊 9(81.8) − 注:−表示无此项数据。TA为多发性大动脉炎;CT为计算机体层摄影术 -
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