Maconi Giovanni, Di Sabatino Antonio, Ardizzone Sandro, Greco Salvatore, Colombo Elisabetta, Russo Antonio, Cassinotti Andrea, Casini Valentina, Corazza Gino Roberto, Bianchi Porro Gabriele
Department of Gastroenterology, L. Sacco University Hospital, Via G.B. Grassi 74, IT-20157 Milan, Italy.
Scand J Gastroenterol. 2005 Nov;40(11):1328-33. doi: 10.1080/00365510510025746.
Reactive regional lymph node enlargement is a frequent ultrasonographic finding in patients with Crohn's disease. However, the prevalence of this condition and its clinical significance are unknown. This study assesses the prevalence of enlarged regional mesenteric lymph nodes and its clinical significance in Crohn's disease, and in particular whether there is a correlation between the sonographic detection of enlarged regional lymph nodes and the degree of clinical or biochemical activity of the disease.
A total of 240 in- and outpatients with Crohn's disease underwent intestinal ultrasound to assess the presence of enlarged regional lymph nodes as well as the thickness and echopattern of the bowel wall, the site and extent of Crohn's disease and the presence of stenosis, fistulas and abscesses. Demographic, clinical and biochemical parameters were also collected for each patient. A multivariate model by means of multiple regression analysis was used to identify independent variables linked to regional lymph node enlargement.
Enlarged regional lymph nodes were detected ultrasonographically in 25.4% of Crohn's disease patients. The presence of regional lymph nodes showed a weak correlation with both clinical and biochemical Crohn's disease activity. Regional lymph nodes were found more frequently in young patients (50% of patients < 30 years, 18% of patients between 30 and 50 yrs, and 7% of patients > 50 yrs; p<0.0001) and in patients with a shorter disease duration. Enlarged regional lymph nodes were strongly correlated with internal fistulas and intra-abdominal abscesses. The multiple regression analysis showed that age, duration of disease and presence of internal fistulas were the best independent predictive factors linked to the presence of enlarged mesenteric lymph nodes.
The sonographic detection of enlarged regional lymph nodes is more frequent in young patients, which suggests an earlier phase of Crohn's disease and the presence of septic complications such as fistulas and abscesses, but this is of limited valued in assessing disease activity.
反应性区域淋巴结肿大是克罗恩病患者常见的超声检查表现。然而，这种情况的发生率及其临床意义尚不清楚。本研究评估了克罗恩病患者肠系膜区域淋巴结肿大的发生率及其临床意义，特别是区域淋巴结肿大的超声检测与疾病的临床或生化活动程度之间是否存在相关性。
共240例克罗恩病门诊和住院患者接受了肠道超声检查，以评估区域淋巴结肿大情况以及肠壁厚度、回声模式、克罗恩病的部位和范围，以及狭窄、瘘管和脓肿的存在情况。还收集了每位患者的人口统计学、临床和生化参数。采用多元回归分析的多变量模型来确定与区域淋巴结肿大相关的独立变量。
25.4%的克罗恩病患者超声检查发现区域淋巴结肿大。区域淋巴结的存在与克罗恩病的临床和生化活动均呈弱相关。区域淋巴结在年轻患者中更常见（<30岁患者中占50%，30至50岁患者中占18%，>50岁患者中占7%；p<0.0001），且疾病病程较短的患者中也更常见。区域淋巴结肿大与内瘘和腹腔内脓肿密切相关。多元回归分析表明，年龄、病程和内瘘的存在是与肠系膜淋巴结肿大相关的最佳独立预测因素。
年轻患者中区域淋巴结肿大的超声检测更为常见，这提示克罗恩病处于早期阶段，且存在瘘管和脓肿等感染性并发症，但这在评估疾病活动方面价值有限。
