高分辨率CT及积分在结缔组织病并发间质性肺炎及预后中的价值

目的 比较不同结缔组织病(CTD)并发间质性肺炎(ILD)的肺高分辨率CT(HRCT)影像学特征,探讨肺HRCT积分对判断患者预后的预测价值.方法 回顾性收集117例各类CTD 临床资料和影像学资料以及随访结果,对肺HRCT病变进行评分,研究肺HRCT积分与患者预后的关系.结果 117例CTD患者中有95例在肺HRCT上显示有ILD,其中,系统性红斑狼疮(SLE)34%,类风湿关节炎(RA)31%,多发性肌炎/皮肌炎(PM/DM)9%,成人斯蒂尔病(AOSD)9%,干燥综合征(SS)5%,系统性硬化症(SSc)7%,混合性结缔组织病(MCTD)5%.CTD并发ILD肺HRCT最常见的表现是小叶间隔增厚,其次为毛玻璃样变,之后依次为不规则线状影或胸膜下线、网格影、支气管血管束增厚、马赛克灌注、蜂窝肺、薄壁囊肿、结节灶、大片实变病变、肺大泡.AOSD和SSc患者纤维化积分显著高于渗出积分(P＜0.05);CTD并发ILD患者5年生存率为48.5%(95%可信区间为22.4%～67.9%),纤维化积分≥2分是预测患者预后不良的危险因素(P=0.032),其敏感性为82%,特异性为87%.结论 不同CTD并发的ILD有不同的影像学特征,肺HRCT可以较好地发现并鉴别,肺HRCT纤维化积分可以判断患者的预后.

The predicting value of high-resolution computed tomography score on the progression and mortality of patienis with connective tissue disease-related interstitial lung disease

Objective To study the imaging characteristics and predictive value of high resolution computed tomography(HRCT)score on the progression and mortality of patients with connective tissue disease(CTD)-related interstitial lung diserse(ILD).Methods 117 case of CTD patients were included in this study and the clinical data were collected.HRCTs were performed with 1.0 mm thick sections throughout the entire thorax and were reconstructed using a high spatial frequency algorithm in all subjects.A score system was used in the study to evaluate the progression and mortality of all the CTD-ILD patients.Results The imaging characteristics of ILD were observed in 95 CTD patients.Thirty-four percent ILD patients were seen in SLE.31%in RA,9%in PM/DM,9%in AOSD,5%in SS,7%in SSc,5%in MCTD.The most im-aging characteristics imaging of IILD abnormalities were interlobular septal thickening,followod by ground glass atten-uation,subpleural reticulation,bronchial wall thickening,mosaic perfusion,honeycombing,thin walled cysts,parenchymal nodules.et al.In patients with adult onset Still's disease(AOSD)and systemic sclerosis (SSc).the fibrotic score was significantly higher than alveolar score,P＜0.05.The 5-year survival rate of patients with CTD-ILD was 48.5%(95%confidence interval 22.4%～67.9%).The sensitivity and specificity were 82%and 87%respectively for HRCT fibrotic score 2.0 or above on mortality in all patients with CTDILD.Conclusion HRCT may be a good tool to detect the imaging characteristics of ILD in CTD patients.A high fibrotic score(≥2.0)could predicts high mortality rate of CTD-ILD patients.