摘要
目的:通过对腹膜后纤维化临床特点及其影像学表现的分析,提高对该病的诊治水平。方法:收集北京大学第一医院风湿免疫科从2009年7月至2011年12月诊断为腹膜后纤维化的32例患者的临床资料,回顾性分析其临床表现,并对其CT/MRI下炎性-纤维包块进行测量和分期;同时观察治疗前后患者临床症状、急性期反应物、肾功能、影像学变化及D-J管拔除情况变化,分析急性期反应物变化与影像学变化之间的相关性。结果:32例患者中男21例,女11例,男女比例为1.91∶1,年龄30～78岁,平均60岁。首诊表现主要包括腹痛、腹胀、腰痛、体重减轻、下肢浮肿等。26例(81.25%)患者经超声检查发现有肾积水,所有患者均经CT/MRI检查发现腹膜后软组织影而确诊。32例患者均接受激素治疗,31例接受他莫昔芬治疗,8例接受免疫抑制剂治疗。随诊的18例患者均接受激素/免疫抑制剂/他莫昔芬治疗,其中13例患者置入D-J管,平均随访14个月。药物治疗后患者症状缓解,红细胞沉降率(erythrocyte sedimentation rate,ESR)和C反应蛋白(C-reactive protein,CRP)下降,肾功能较前改善,腹膜后纤维化包块较前明显缩小,D-J管平均置管时间为13.1个月,拔管率80%。平均治疗8.1个月后,ESR、CRP变化与CT/MRI腹膜后软组织左右径线变化的相关系数分别为0.50、0.66(P<0.05)。结论:腹膜后纤维化临床表现多样且不特异,确诊主要依靠影像学检查。药物治疗可缓解患者症状,降低急性期反应物,改善肾功能和影像学表现,提高拔管率。治疗前后的ESR、CRP变化与CT/MRI软组织包块左右径线变化呈正相关。
Objective：To analyze the clinical features and imaging manifestations of retroperitoneal fibrosis（RPF） for improving clinical diagnosis and treatment.Methods：The medical records of 32 cases from Jul.2009 to Dec.2011 with definite diagnosis of RPF were reviewed retrospectively,and the fibro-inflammatory tissue in CT/MRI imagings were classified and measured.The clinical symptoms,the acute phase reactants,kidney function,and radiological imaging,with or without double-J ureteral stenting were observed and compared between prior and post medications and their correlations were also analysed.Results：The average age at onset was 60 years,ranging from 30-78,with male-to-female ratio of 1.91∶ 1.Among these 32 cases,the most common presenting manifestations included abdominal pain,abdominal distension,lumbago,loss of body weight,and pitting edema of lower extremities.Hydronephrosis was found by colour doppler untrasonography in 26（81.25%） patients.RPF was confirmed by typical CT/MRI imagings in all the patients.All of the patients in our study were treated with corticosteroids and in combination with tamoxifen or immunosuppressive agents in most of the patients,of whom 18 patients were followed up for an average of 14 months.After drug therapy,the patients＇ symptoms were relieved,ESR and CRP droped,renal function improved,and the size of RPF reflected in CT/MRI imagings became smaller significantly.The average time of removal double-J ureteral stenting was 13.1 months and the extubated rate was 80%.The correlation coefficients between changes of ESR or CRP and transverse diameter in CT/MRI imagings were 0.50 or 0.66（P 0.05） respectively.Conclusion： The presenting manifestations of RPF were nonspecific.However,it is extremely important to recognize RPF,because early drug therapy could alleviate symptoms and reduce the acute phase reactants,improve renal function and improve imaging and extubated rate.When compared with the changes between prior and post medications,changes of ESR and CRP had good correlations with CT/MRI imaging changes respectively.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第2期265-269,共5页
Journal of Peking University:Health Sciences
关键词
腹膜后纤维化
磁共振成像
糖皮质激素
治疗结果
他莫昔芬
Retroperitoneal fibrosis
Magnetic resonance imaging
Glucocorticoids
Treatment outcome
Tamoxifen
