硅胶乳房植入物：植入物破裂、磁共振波谱法估计肝脏中硅胶的存在、抗体状态与临床症状之间的相关性。

Silicone breast implants: correlation between implant ruptures, magnetic resonance spectroscopically estimated silicone presence in the liver, antibody status and clinical symptoms.

作者信息

Gaubitz M, Jackisch C, Domschke W, Heindel W, Pfleiderer B

机构信息

Department of Medicine B, University of Münster, Münster, Germany.

出版信息

Rheumatology (Oxford). 2002 Feb;41(2):129-35; discussion 123-4. doi: 10.1093/rheumatology/41.2.129.

DOI:10.1093/rheumatology/41.2.129

PMID:11886959

Abstract

OBJECTIVE

To determine the impact of implant integrity on clinical symptoms and antibody status in women with silicone breast implants (SBIs).

METHODS

Ninety consecutive women were examined by means of magnetic resonance imaging (MRI) to assess the integrity of their silicone breast implants. The presence of silicone in the liver was estimated by (1)H localized stimulated echo acquisition mode (STEAM) magnetic resonance spectroscopy (MRS). Results were correlated with patients' complaints, as evaluated by a standardized questionnaire, physical examination by a rheumatologist and antibody screening.

RESULTS

Breast MRI revealed defects in 24 patients (26.6%); in 13 (54.2%) of these women, silicone was detected in the liver by MRS. Of the 66 patients with MRI-estimated intact implants, 15 (22.7%) had apparent silicone in their liver, arguing for gel bleeding. Clinically, two patients had had rheumatoid arthritis before SBIs, whereas the other patients revealed no typical symptoms of arthritis or connective tissue disease (CTD). The patients with MRS evidence of silicone in the liver had no statistically significant differences in their complaints with the exception of the most frequent symptom, tingling/numbness of the fingers (82.1 vs 51.6%, P=0.006). A positive pattern of antinuclear antibodies (ANA) was obtained in 13 of the 28 MRS-positive patients (46.4%) and in 15 of the 62 MRS-negative patients (24.2%, P=0.033). However, in only one of these 28 ANA-positive patients was a specific weak antibody titre against SS-A detected by ELISA.

CONCLUSION

Implant integrity has no major impact on rheumatic symptoms of women with SBIs. This finding supports the standpoint that silicone does not cause either a specific CTD or any other distinct disease entity. However, the moderately increased incidences of ANA-positivity and neuropathy-associated symptoms require explanation.

摘要

目的

确定植入物完整性对硅胶乳房植入物（SBI）女性患者临床症状和抗体状态的影响。

方法

对90名连续的女性进行磁共振成像（MRI）检查，以评估其硅胶乳房植入物的完整性。通过（1）H局部刺激回波采集模式（STEAM）磁共振波谱（MRS）估计肝脏中硅胶的存在情况。结果与患者的主诉相关，主诉通过标准化问卷、风湿病学家的体格检查和抗体筛查进行评估。

结果

乳房MRI显示24名患者（26.6%）存在植入物缺陷；在这些女性中的13名（54.2%），通过MRS在肝脏中检测到硅胶。在MRI估计植入物完整的66名患者中，15名（22.7%）肝脏中有明显的硅胶，提示凝胶渗漏。临床上，两名患者在植入SBI之前患有类风湿性关节炎，而其他患者未表现出关节炎或结缔组织病（CTD）的典型症状。肝脏中有硅胶MRS证据的患者，除了最常见的症状手指刺痛/麻木外（82.1%对51.6%，P = 0.006），其主诉在统计学上无显著差异。28名MRS阳性患者中有13名（46.4%）抗核抗体（ANA）呈阳性模式，62名MRS阴性患者中有15名（24.2%，P = 0.033）呈阳性模式。然而，在这28名ANA阳性患者中，只有1名通过酶联免疫吸附测定（ELISA）检测到针对SS - A的特异性低抗体滴度。