心脏移植评估患者的纵隔淋巴结病。
Mediastinal lymphadenopathy in patients undergoing cardiac transplant evaluation.
机构信息
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
Division of Cardiology, Medical University of South Carolina, Charleston, SC.
出版信息
Chest. 2011 Jun;139(6):1451-1457. doi: 10.1378/chest.10-1386. Epub 2010 Oct 21.
BACKGROUND
We evaluated the association between hemodynamic parameters of chronic congestive heart failure (CHF) and mediastinal lymphadenopathy (MLA) in heart transplantation (HT) candidates and the effect of HT on MLA. We also described the results of lymph node (LN) biopsies of MLA in the patients.
METHODS
Patients who underwent HT evaluation over an 8-year period and had chest CT scans were evaluated retrospectively. Data collected included LN sizes pre-HT and post-HT, echocardiographic measurements, radionuclide-derived ejection fraction, and right-sided heart catheterization hemodynamics. MLA was defined as LNs > 1 cm in smallest dimension.
RESULTS
Of 118 patients, 53 patients had MLA. MLA had weak statistically significant correlations with elevated mean pulmonary artery pressure (MPAP), mitral regurgitation (MR), tricuspid regurgitation (TR), right atrial pressure (RAP), and pulmonary capillary wedge pressure (PCWP). Thirty-six patients with MLA underwent HT, and nine of the 36 had post-HT chest CT scans. All nine patients showed a decrease in LN size post-HT (mean LN diameter pre-HT = 1.16 ± 0.137 cm, post-HT = 0.75 ± 0.32 cm). Seven of 53 patients with MLA underwent biopsies. Four had benign LNs, one had sarcoidosis, and two had lung cancer.
CONCLUSIONS
MPAP, MR, TR, RAP, and PCWP had weak statistically significant correlations with MLA. HT led to regression of MLA in patients who underwent CT scans post-HT, implying that MLA is related to CHF. However, we also identified clinically important causes of MLA; therefore, biopsy should be considered if enlarged LNs fail to regress after maximal medical management of CHF.
背景
我们评估了慢性充血性心力衰竭（CHF）患者的血流动力学参数与纵隔淋巴结病（MLA）之间的关系，以及心脏移植（HT）对 MLA 的影响。我们还描述了 MLA 患者淋巴结（LN）活检的结果。
方法
回顾性评估了在 8 年内接受 HT 评估且有胸部 CT 扫描的患者。收集的数据包括 HT 前和 HT 后的 LN 大小、超声心动图测量值、放射性核素衍生的射血分数和右侧心导管血流动力学。MLA 定义为最小尺寸大于 1cm 的 LN。
结果
在 118 例患者中，有 53 例患者有 MLA。MLA 与肺动脉平均压（MPAP）升高、二尖瓣反流（MR）、三尖瓣反流（TR）、右心房压（RAP）和肺毛细血管楔压（PCWP）有弱的统计学显著相关性。36 例 MLA 患者接受了 HT，其中 9 例在 HT 后进行了胸部 CT 扫描。所有 9 例患者在 HT 后 LN 大小均减小（HT 前 LN 直径平均值=1.16±0.137cm，HT 后=0.75±0.32cm）。53 例有 MLA 的患者中有 7 例接受了活检。其中 4 例为良性 LN，1 例为结节病，2 例为肺癌。
结论
MPAP、MR、TR、RAP 和 PCWP 与 MLA 有弱的统计学显著相关性。HT 导致接受 CT 扫描后患者的 MLA 消退，这表明 MLA 与 CHF 有关。然而，我们还确定了 MLA 的重要临床原因；因此，如果心力衰竭的最大药物治疗后 LN 未能消退，应考虑进行活检。
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