高分辨率CT在结缔组织病并发间质性肺炎的早期诊断价值

杨奕; 冯艳; 李志军

doi:10.13898/j.cnki.issn.1000-2200.2018.03.028

摘要: 目的：比较肺高分辨率CT（HRCT）在不同结缔组织病（CTD）并发间质性肺炎（ILD）的影像学特征，为HRCT在CTD并发ILD早期诊断提供依据。方法：选取1 388例CTD病人资料，其中CTD并发ILD 143例（总发病率为10.3%），分析CTD并发ILD病人肺HRCT影像学特征，探讨CT分类与不同CTD实验室指标间的关系。结果：143例CTD合并ILD病人中系统性红斑狼疮（SLE）53例，类风湿关节炎（RA）40例，干燥综合征（SS）26例，多发性肌炎/皮肌炎（PM/DM）8例，系统性硬化症（SSc）7例，混合性CTD（MTCD）5例，成人斯蒂尔病（AOSD）4例。CTD并发ILD肺HRCT影像学表现依次为：小叶间隔增厚88.1%；毛玻璃样变78.3%；不规则线状影或胸膜下线74.1%；网格影41.3%；支气管血管束增厚30.1%；薄壁囊肿23.8%；蜂窝肺、结节灶均占19.6%；马赛克灌注17.5%；实变影10.5%；肺大泡5.6%。SLE、RA、SS、AOSD以毛玻璃样变、小叶间隔增厚影像学表现为主，SSc、PM/DM、MCTD以网格影、蜂窝肺为主要表现。不同CT类型肺间质病变组红细胞沉降率（ESR）、C反应蛋白（CRP）、C3、C4比较，差异均有统计学意义（P<0.01）。网格影组、实变影组、蜂窝肺组、毛玻璃样变组、Non-ILD组ESR指标均高于不规则线下影或胸膜下线组（P<0.05~P<0.01）；实变影组、蜂窝肺组、毛玻璃样变组CRP指标均高于Non-ILD组（P<0.05~P<0.01）；不规则线下影或胸膜下线组、网格影组、薄壁囊肿组、支气管学管束增厚组、蜂窝肺组、小叶间隔增厚组、Non-ILD组C3指标均低于毛玻璃样变组（P<0.05~P<0.01），不规则线下影或胸膜下线组、实变影组C3指标均高于Non-ILD组（P<0.05~P<0.01）；除肺大泡组外，其余各组C4指标均显著低于毛玻璃样变组（P<0.01）。结论：不同CTD并发ILD有不同影像学特征，影像学改变与炎症指标及补体水平有一定关系，早期进行肺部HRCT检查有助于ILD早期诊断及预后判断。

Abstract: Objective:To analyze the imaging features of lung high resolution CT(HRCT) in different connective tissue disease(CTD) complicated with interstitial pneumonia(ILD),and provide the basis for the HRCT in the early diagnosis of CTD complicated with ILD.Methods:Among 1388 patients with CTD,the imaging features of pulmonary HRCT in 143 patients with CTD complicated with ILD(total incidence rate for 10.3%) were investigated.The relationship between CT classification and different CTD laboratory indexes were analyzed.Results:Among 143 patients with CTD complicated with ILD,the systemic lupus erythematosus(SLE) in 53 cases,rheumatoid arthritis(RA) in 40 cases,sicca syndrome in 24 cases,polymyositis/dermatomyositis in 8 cases,systemic sclerosis(SSc) in 7 cases,mixed connective tissue disease(MTCD) and adult onset still's disease(AOSD) in 4 cases were identified.The imaging features of HRCT in patients with CTD complicated with ILD mainly included the septal thickening(88.1%),ground-glass opacity(78.3%),irregular linear opacities or subpleural line(74.1%),grid shadow(41.3%),bronchovascular bundle thickening(30.1%),thin-walled cyst(23.8%),honeycomb lung(19.6%),focal nodules(19.6%),mosaic perfusion opacities(10.5%),consolidation shadow(10.5%) and pulmonary bullae(5.6%).The ground-glass opacity and lobular interval thickening were the main imaging features of SLE,RA,SS and AOSD,and the grid shadow and honeycomb lung were the main imaging features of SSc,PM/DM and MCTD.The differences of the levels of ESR,CRP,C3 and C4 between different CT types of lung interstitial lesions were statistically significant(P<0.01).The ESR indexes in the grid shadow group,real shadow group,honeycomb lung group,ground-glass opacity and non-ILD group were higher than those in irregular line group or subpleural group(P<0.05 to P<0.01).The CRP indexes in the real shadow group,honeycomb lung group and ground-glass opacity group were higher than those in non-ILD group(P<0.05 to P<0.01).The C3 indexes in the irregular line group or subpleural group,thin-walled cysts group,bronchial tube bundle thickening group,honeycomb lung group,lobular interval thickening group and non-ILD group were lower than those in ground-glass opacity group(P<0.05 to P<0.01).The C3 indexes in irregular line group or subpleural group and real shadow group were higher than those in non-ILD group(P<0.05 to P<0.01).In addition to the pulmonary bullae group,the C4 index in other groups were significantly lower than those in ground-glass opacity group(P<0.01).Conclusions:Different CTD complicated with ILD have different imaging features,inflammation indexes and complement levels.The early lung HRCT examination is helpful to the early diagnosis of ILD,and predict the prognosis.

高分辨率CT在结缔组织病并发间质性肺炎的早期诊断价值

Early diagnosis value of high-resolution CT in connective tissue disease complicated with interstitial pneumonia