系统性硬化症肺部受累的胸部高分辨力CT表现特点分析

目的分析系统性硬化症（SSc）肺部受累时胸部高分辨力计算机体层摄影术（HRCT）表现,提高对SSc肺部损害的认识。方法选择2009年1月~2012年6月明确诊断的45例SSc患者,其中男性9例,女性36例;年龄为20~80岁,平均年龄58.50岁。回顾其胸部HRCT表现,并进行HRCT评分,对其胸部HRCT特点进行总结分析。结果胸部HRCT证实,存在间质性肺疾病患者为32例（71.1%）,其中34.4%患者（11/32）无呼吸系统症状。SSc肺部受累在HRCT图像上以磨玻璃影（81.3%）和网格影（56.3%）最为常见,分布以双下肺（71.9%）及胸膜下分布（81.3%）为主。对两侧的上中下肺野的HRCT评分进行t检验发现双侧病变差异无统计学意义（P〉0.05）,呈对称性分布。对上中下肺野的HRCT评分进行两两比较,下肺野受累最明显,中野次之,上野受累最少（P〈0.05）。在存在肺间质受累的患者中,弥漫型患者的HRCT评分（8.82±5.56）与局限型患者的评分（8.73±5.61）间差异无统计学意义（P〉0.05）。肺外胸部脏器受累包括肺动脉增宽、胸膜病变、心包积液、纵隔淋巴结肿大、食管扩张。肺动脉增宽33.3%（15/45）,弥漫型患者中肺动脉增宽的发生率与局限型患者的发生率差异无统计学意义;有雷诺现象者的肺动脉增宽的发生率高（15/34 vs 0/11;P=0.005）。结论胸部HRCT对SSs的肺、胸膜、食道、肺动脉的评估均有较高价值,其中肺间质受累是最为常见的,对称性分布、双下肺突出的间质性病变为其主要特点。

Analysis of high-resolution computed tomography findings in systemic sclerosis associated pulmonary involvements

Objective To summarize high-resolution computed tomography（HRCT） manifestations of the chest involvement of systemic sclerosis（SSc）,and improve its recognition.Methods From January 2009 to June 2012,45 patients with SSc were enrolled,included 9 males and 36 females,who were 20-80 years old with a mean age of 58.50.All of chest HRCT was analyzed to evaluate the chest involvements,and chest HRCT findings were scored and analyzed.Results The pulmonary involvements detected by HRCT were 32 cases（71.1 %）,in which 34.4 %（11/32） had no respiratory symptoms.The interstitial lung changes of SSc on HRCT were mainly ground glass opacity（81.3 %） and reticular changes（56.3 %）,predominantly distributed at lower fields（71.9 %） and sub-pleural areas（81.3 %）.The comparison of bilateral HRCT scores of upper,middle and lower fields via t-test proved symmetrical distribution of pulmonary involvement（P 0.05）.The pair-comparison of pulmonary involvement of upper,middle and lower fields showed the most obvious involvement in lower field,second in middle field and modest in upper field（P 0.05）.The HRCT score of pulmonary involvement showed no significant difference between diffusive systemic sclerosis（8.82 ± 5.56） and limited systemic sclerosis（8.73 ± 5.61）（P 0.05）.The extra-pulmonary involvements included widened pulmonary artery,pleural changes,pericardial effusion,mediastinal lymph node enlargements and esophagectasia.The pulmonary artery widening was observed in 33.3 %（15/45） with no significant difference between diffusive and limited subtypes,while the presence of pulmonary artery widening was more commonly observed in Reynaud phenomenon patients than those without Reynaud phenomenon（15/34 vs 0/11;P = 0.005）.Conclusion It is demonstrated that chest HRCT is useful to assess the involvement of lung,pleura,esophagus and pulmonary arteries of SSc patients,in which interstitial lung changes are most common with symmetrically lower zones as predominant distributions.