CT Evaluation Of Lymph Node Enlargement Associated With Connective Tissue Disease And Its Clinical Significance

Part?:CT evaluation of lymphadenopathy of systemic lupus erythe-matosus and its clinical significanceObjective:To explore the clinical significance of axillary/mediastinal lymph nodes in patients with SLE.Methods:Retrospective analysis of lymph node signs and related clinical data of 400 cases of newly diagnosed SLE patients diagnosed and treated in our hospital from April 2018 to September 2019.According to the presence or absence of lymphadenopathy on chest CT,they were divided into LAP group and non-LAP group,with 200 cases in each group.The clinical manifestations,laboratory results,and disease activity differences were compared between the two groups.Analyze the areas of thoracic lymphadenopathy that may be easily affected.In order to explore the signs of enlarged lymph nodes and the possible relationship between different parts and the disease process.Results:1. LAP and non-LAP groups:Clinical manifestations showed that the incidence of hair loss,photosensitivity,arthritis,and splenomegaly in the LAP group were higher than those in the non-LAP group(20.5%vs 11.1%;8.0%vs 2.5%;50.0%vs35%;20.5%vs 8.5%),the difference was statistically significant[x~2=6.801,0.001];the incidence of renal damage in patients in the LAP group was low In the non-LAP group(31.5%vs 48.0%),the difference was statistically significant(x~2=11.368,P=0.001);the age of onset in the LAP group was lower than that in the non-LAP group[(34.24±0.98)vs(38.65±1.05)],the difference was statistically significant(t=3.057,P=0.002).Laboratory examination results showed that the white blood cell counts and complement C3 and C4 levels of patients in the LAP group were lower than those in the non-LAP group[(0.40±0.21)10~9/L vs(5.78±0.30)10~9/L;(0.45±0.02)g/L vs(1.63±0.29)g/L;(0.08±0.00)g/L vs(0.15±0.02)g/L],the difference was statistically significant(t=3.752,P<0.001;t=3.992,P<0.001;T=5.084,P<0.001),and the erythrocyte sedimentation rate,immunoglobulin G,and disease activity index scores were higher than those in the non-LAP group[(49.55±2.43)mm/h vs(41.05±2.38)mm/h;(19.89±0.57)g/L vs(13.74±0.56)g/L;(12.18±0.37)vs(11.18±0.32)],the difference is statistically significant(t=-2.503,P=0.013;t=-7.669,P<0.001;t=-2.014,P=0.045);the positive rates of serum antinuclear antibodies,anti-double-stranded DNA antibodies,and anti-Sm antibodies in patients with LAP group were higher than those in non-LAP group(97.5%vs88.1%;71.1%vs 51.6%;69.1 vs 42.4%),the difference was statistically<0.001).Logistic regression analysis showed that the risk factors for lymphadenopathy in patients with SLE were complement C3(OR=3.029,P=0.047),immunoglobulin G(OR=2.710,P<0.001),and disease activity index score(OR=1.124,P=0.020),and the age of onset(OR=0.259,P=0.041),renal damage(OR=0.254,P=0.002)were the protective factors;2. The LAP group is further divided into:axillary group,mediastinal group,axillary+mediastinal group:Clinical manifestations showed that the incidence of serositis in patients in the mediastinum group was higher than that in the other two groups(14.3%vs 62.5%vs 30.5%),and the difference was statistically significant(x~2=15.134,P=0.001);of which mediastinal The onset age of the group was higher than that of the other two groups((31.42±1.068)vs(58.00±3.105)vs(37.36±1.849)),and the difference was statistically significant(F=18.770,P<0.001).The results of laboratory tests showed that the levels of complement C4in patients in the axillary and mediastinal group were lower than those in the axillary and mediastinal group[(0.083±0.005)g/L vs(0.139±0.035)g/L vs(0.079±0.008)g/L],The difference is statistically significant(F=3.664,P=0.027);the erythrocyte sedimentation rate in the mediastinum group is higher than the other two groups[(45.51±2.801)mm/h vs(68.00±16.030)mm/h vs(56.44±4.672)mm/h],the difference is statistically significant(F=3.361,P=0.037);the positive rate of anti-Sm antibodies in the armpit+mediastinum group was higher than in the other two groups(70.5%vs 16.7%vs 71.7%).),The difference was statistically significant(x~2=7.998,P=0.018).Logistic regression analysis showed that the risk factors for LAP in the axillary group of SLE patients were renal damage(OR=9.274,P<0.001)and disease activity index(SLEDAI)score(OR=1.163,P<0.001);LAP occurred in the mediastinal group.The risk factors were the age of onset(OR=1.13,P=0.011);the risk factors for LAP in the axilla and mediastinum of SLE patients were renal damage(OR=4.803,P=0.001)and disease activity index(SLEDAI)score(OR=1.148,P=0.003).Conclusions:LAP is one of the common clinical manifestations in patients with SLE,and it may indicate that multi-system damage is more likely to occur during SLE disease.The occurrence of LAP in SLE patients may be related to the age of onset,some clinical manifestations,and serology.LAPs are not the same.Part?: CT evaluation of rheumatoid arthritis lymphadenopathy and its clinical significanceObjective: To explore the clinical significance of axillary / mediastinal lymph nodes in RA patients.Methods: Retrospective analysis of lymph node signs and related clinical data of 400 patients with initial RA diagnosed and treated in our hospital from April 2018 to September 2019.According to the presence or absence of lymphadenopathy on chest CT,they were divided into LAP group and non-LAP group,with 200 cases in each group.The patients in the LAP group were divided into axillary group,mediastinal group,and axillary + mediastinal group according to the affected sites.The clinical manifestations,laboratory results,and disease activities of the two groups were compared.In order to explore the signs of enlarged lymph nodes and the correlation between the enlarged lymph nodes in different parts and the disease performance.Results:1.LAP and non-LAP groups:The clinical manifestations showed that the number of medium and large joints and the total number of joints involved in the LAP group were higher than those in the non-LAP group [(5.36 ± 0.19)vs(4.66 ± 0.21);(17.86 ± 0.69)vs(16.06 ± 0.68)],the difference was There was statistical significance(t =-2.523,P = 0.012;t =-2.172,P = 0.030).The results of laboratory tests showed that the erythrocyte sedimentation rate,C-reactive protein,immunoglobulin G levels,and SDAI scores of patients in the LAP group were higher than those in the non-LAP group [(75.80 ± 2.25)mm / h vs(58.99 ± 2.29)mm / h;(56.20 ± 3.33)mg / L vs(45.88 ± 3.38)mg / L;(16.14 ± 0.37)g / L vs(13.63 ± 0.30)g / L;(41.19 ± 0.94)vs(37.39 ± 0.88)],the difference has Statistical significance(t =-5.240,P <0.001;t =-2.174,P = 0.030;t =-5.311,P <0.001;t =-2.964;P = 0.003);serum rheumatoid factor in patients with LAP group The positive rates of anti-cyclic citrulline antibodies were higher than those in the non-LAP group(82.1% vs 72.0%;90.7 %% vs 80.1%),the difference was statistically significant(x2 = 5.647,P = 0.017;x2 = 8.811,P = 0.003).Logistic regression analysis showed that the risk factors for lymphadenopathy in RA patients were the number of large and medium joints(OR = 1.087,P = 0.047),positive anti-cyclocitrulline antibody(OR = 2.527,P = 0.007),and red blood cell sedimentation.Rate(OR = 1.012,P = 0.001),immunoglobulin G level(OR = 1.102,P = 0.001)and SDAI score(OR =1.213,P = 0.021).2.The LAP group is further divided into: axillary group,mediastinal group,and axillary + mediastinal group:The age of onset in the armpit + mediastinum group was higher than that in the other two groups((53.81 ± 1.184)vs(57.09 ± 3.481)vs(60.30 ± 1.555)),and the difference was statistically significant(F = 4.808,P = 0.009).The proportion of female patients in the armpit group was more than the other two groups(77.0% vs 64.5% vs 59.3%),and the proportion of male patients in the mediastinum group was more than the other two groups(23.0% vs 45.5% vs 40.7%)The difference was statistically significant(x~2 = 7.451,P = 0.024).Conclusions: LAP is one of the common clinical manifestations of RA patients,and it may indicate that multiple systemic damage is more likely to occur in the course of RA disease.There may be a correlation between LAP associated with LAP and some clinical manifestations and serology.There were differences between the age of onset and sex.