高分辨率CT半定量分值判断特发性间质性肺炎患者应用糖皮质激素的近期疗效

目的 评价高分辨率CT(HRCT)半定量分值对于特发性间质性肺炎(IIP)患者糖皮质激素(简称激素)近期治疗反应和预后的意义.方法 回顾性分析2001年1月至2007年5月北京大学第三医院收治的83例IIP患者.HRCT选择气管分叉处、左心房顶、右膈肌顶3个层面作为研究对象.计算网格影和蜂窝病变在3个层面上所占百分比的算术均值(HRCT分值),分别以HRCT分值10%、20%、30%、40%和50%为临界点,判断激素治疗效果的敏感度、特异度和准确度.独立样本采用.t检验或秩和榆验,定性资料采用x2检验.结果 以HRCT分值20%为临界点的准确度最高(70.6%).将83例中使用激素治疗的51例分为HRCT分值≥20%组25例,<20%组26例,其住院期问病死率分别为40.0%和3.8%(X2=9.848,P<0.01),激素近期治疗有效率分别为8.0%和50.0%(x2=10.829,P<0.01),平均住院时间的中位数(四分位间距)分别为3.0(1.0～6.5)个月和1.2(0.7～2.0)个月(z=-2.758,P<0.01),病程的中位数(四分位间距)分别为24.0(4.0～48.0)个月和2.0(1.0～12.0)个月(z=-2.900,P<0.01).共15例明确病珲分型,其中HRCT分值≥20%组4例,均为普通型问质性肺炎(UIP);<20%组11例,分别为急件问质性肺炎1例,UIP 1例,非特异性问质性肺炎9例.结论 HRCT分值有助于判断IIP患者激素治疗的近期反应.HRCT分值20%足较为合适的临界值,并与病理诊断具有较好的一致性.

High-resolution CT semi-quantitative score may have a role in predicting short-term response to corticosteroid therapy in idiopathic interstitial pneumonias

Objective To investigate HRCT semi-quantitative score in the response to corticosteroid treatment and prognosis in idiopathic interstitial pneumonia(IIP) patients.Methods Data from 83 IIP patients admitted in Peking University Third Hospital from January,2001 to Mav,2007 were retrospectively studied.Three sections of HRCT scans were analyzed,including the level of the tracheal canna,left atrium,and right diaphragmatic dome.The mean of percentage of reticular pattern and honeycombing on the 3 HRCT sections was calculated(HRCT score).To predict the sensitivity,specificity,and accuracy of the response to corticosteroid treatment when HRCT score was 10%,20%,30%,40%,50% as cutoff value.Software SPSS 11.0 was used for statistical analysis,the t test or Mann-Whitney u tests for quantitative variables and the chi-square test for qualitative variables.Results The most accurate(70.6%)cutoff value was HRCT score of 20%.In 83 IIP patients 51 cases were treated with corticosteroid.These patients were divided into 2 groups by the HRCT score:HRCT score≥120% group (n=25) and HRCT score<20% group(n=26).The mortality in hospital was 40.0% in HRCT score ≥20% group and 3.8% in HRCT score<20% group,x2=9.848,P<0.01.The percentage of effective treatment with corticosteroid was 8.0%in HRCT score ≥20% group and 50.0% in HRCT score<20%group,x2=10.829,P<0.01.The duration of hospitalization was 3.0(1.0-6.5) and 1.2(0.7-2.0) months in HRCT score ≥20% group and <20% group,z=-2.758,P<0.01.The course of IIP before using corticosteroid was 24.0(4.0-48.0)and 2.0(1.0-12.0)months in HRCT score ≥20% group and <20% group,z=-2.900,P<0.01.Pathologic pattern was identified in 15 cases in the 2 groups:4 UIP cases in group HRCT score≥20%;1 AIP cage,1 UIP case and 9 NSIP cases in group HRCT score <20%.Conclusions HRCT score helps to predict the recent response to corticosteroids.An HRCT score of 20% was an appropriate cutoff value and showed consistency with pathologic diagnosis.