Pathological assessment of the lymph node biopsies for lymphadenopathy in rheumatoid arthritis.
Pathological assessment of the lymph node biopsies for lymphadenopathy in rheumatoid arthritis.
复制标题
类风湿性关节炎淋巴结病淋巴结活检的病理学评估。
DOI：
10.1080/14397595.2019.1675260
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
12th)
中科院分区：
文献类型：
--
作者：
Yamada C;Hoshida Y;et al. (12;12th)
目的：探讨类风湿性关节炎（RA）患者反应性淋巴结增生（RLH）的发生率及其与淋巴增生性疾病（LPD）的鉴别诊断特征。方法：收集在同一医疗中心连续就诊的32例RA伴淋巴结病变患者6年以上的患者特征数据并进行分析，以确定是否有任何这些特征可以区分RLH和LPD。结果：LPD包括甲氨蝶呤（MTX）相关LPD (MTX-LPD) 19例，RLH 10例。其余3例未得到结论性诊断，被视为灰色地带病例。LPD患者的年龄、乳酸脱氢酶（LDH）和可溶性白介素-2受体（sIL-2R）水平以及最大标准化摄取值（SUVmax）均显著高于RLH患者。根据RLH和LPD的受试者工作特征曲线分析，这些参数的诊断截止值分别为66年、169 U/L、899 U/mL和8.18。结论：大约三分之一以淋巴结病变为表现的RA患者有反应性淋巴结肿大。年龄越大，LDH、sIL-2R和suvmax水平越高，与LPD的相关性越大，在决定进行活检时不应考虑这些因素。
Objectives:To assess the incidence of reactive lymph node hyperplasia (RLH) and the diagnostic characteristics that can help differentiate it from lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis (RA).Methods:Data on patient characteristic from 32 consecutive RA patients with lymphadenopathy at a single medical center over a 6-year period were collected and analyzed to determine whether any of these characteristics can differentiated RLH from LPD.Results:LPD including methotrexate (MTX) - associated LPD (MTX-LPD) and RLH were diagnosed in 19 and 10 patients, respectively. Conclusive diagnosis was not reached in the remaining three cases and they were regarded as grey-zone cases. Age, levels of lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R), as well as maximum standardized uptake value (SUVmax), were significantly higher in LPD than in RLH patients. The diagnosis cut-off values for these parameters were 66 year, 169 U/L, 899 U/mL and 8.18, respectively, based on the receiver operating characteristics curve analysis for both RLH and LPD.Conclusions:About one-third of patients with RA who presented with lymphadenopathy had reactive lymph node enlargement. Older age and higher levels of LDH, sIL-2R, and SUVmaxare more associated with LPD than should be considered when deciding to perform a biopsy.