散发型淋巴管肌瘤病患者的骨骼病变

目的 回顾性分析散发型淋巴管肌瘤病（sporadic lymphangioleiomyomatosis,S-LAM）患者骨骼结节的发生率、数量、形状及分布情况,并与正常对照组骨岛进行比较。方法 ①S-LAM组：2008年5月～2013年10月,于北京协和医院就诊的S-LAM患者53例,全部为女性,年龄26～64岁,平均年龄39.3岁;②对照组：2013年1～11月,于北京协和医院进行常规体格检查的女性（既往体健,年龄＜55岁）,年龄21 ～51岁,平均年龄33.7岁。行胸腹盆CT检查,使用机器为Siemens64排CT SOMATOM Sensation 64、Siemens 128排CT SOMATOM Definition Flash和Toshiba 320排CT Aquilion ONE 640,扫描范围从胸膜顶至耻骨联合下缘,扫描层厚7mm,层间距7mm,调至骨窗：窗宽2000HU,窗位400HU。采用Excel 2003软件进行数据录入及整理,SPSS19。0软件进行统计分析,组间比较采用秩和检验。结果 S-LAM组患者骨骼结节发生率高于正常对照组;S-LAM组患者骨骼结节数目明显多于正常对照组,二者差异具有统计学意义（P ＜0.05）;S-LAM组中有5例患者共16个塑型样骨骼结节,所占比例分别12.50％（5/40）及4.75％（16/337）,而对照组中上述比例均为0％。该差异应引起关注;S-LAM患者骨骼结节可发生于胸腹盆CT扫描所得图像的各个部位,包括胸椎、肋骨、腰椎、骶尾骨、骨盆以及锁骨、胸骨、肩胛骨、部分肱骨和股骨。结论 SLAM患者的骨骼结节应引起临床医生及放射科医生的普遍关注,并有望将其作为补充条件纳入诊断指南中,提高疑诊病例的确诊率。

Sclerotic Bone Lesions in Patients with Sporadic Lymphangioleiomyomatosis

Objective The purpose of this study was to respectively analyse the number,shape and distribution of sclerotic bone lesions in patients with sporadic lymphangioleiomyomatosis（S-LAM） in comparison with subjects of the normal control group.Methods ①A total of 53 patients in Peking Union Medical College Hospital （PUMCH）during the period from May 2008 to October 2013 were,included in the S-LAM group（male 0,female 53; ages 26-64,mean 39.3） ;②53 females who came to PUMCH for routine medical examinations during the period from January 2013 to November 2013 were randomly selected as the normal control group（without identified medical history,under the age of 55; ages 21-51,mean 33.7）.All the subjects above underwent thoracic and abdominopelvic CT axial scans,using SOMATOM Sensation 64,SOMATOM Definition Flash and Aquilion ONE 640.The relevant parameters were as follows：thickness 7mm,window width：2000HU,window level：400HU.Excel 2003 and SPSS 19.0 were used for data entry and statistical analysis respectively,and Wilcoxon signed rank test was used for comparison between groups.Results The S-LAM group has a higher incidence rate of sclerotic bone lesions than the normal control group （75.47％ vs 58.49％）.The number of sclerotic bone lesions in patients of S-LAM group is significantly more than that of the normal control group,with the difference being statistically significant （P ＜ 0.05）.Patients of S-LAM group have higher ratio of conformed sclerotic bone lesions to the total number of sclerotic bone lesions,to which more attention should be paid.The sclerotic bone lesions in patients of S-LAM group could be observed in all kinds of bones contained in the thoracic and abdominopelvic CT images,including thoracic vertebra,rib,lumbar vertebra,sacrum,coccyx,clavicle,sternum,scapula and partial humerus and femur.Conclusion The sclerotic bone lesions of patients with S-LAM should raise general concern in both clinicians and radiologists,and be expected to join the diagnostic guidelines,thus