切换至 "中华医学电子期刊资源库"

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (06) : 875 -881. doi: 10.3877/cma.j.issn.1674-6902.2024.06.005

论著

结缔组织疾病相关间质性肺病肺部超声与疾病严重程度的相关性
梁波1, 张春雨2, 郑永财2, 徐冰3, 蒋敏娜1, 赵学刚1, 刘晓敏,1   
  1. 1.101300 北京,北京市顺义区医院,首都医科大学顺义教学医院风湿免疫科
    2.101300 北京,北京市顺义区医院,首都医科大学顺义教学医院超声科
    3.101300 北京,北京市顺义区医院,首都医科大学顺义教学医院放射科
  • 收稿日期:2024-05-14 出版日期:2024-12-25
  • 通信作者: 刘晓敏
  • 基金资助:
    北京市顺义区医院科研发展专项基金资助项目(顺医2023Z03)

Association of pulmonary ultrasound with disease severity in connective tissue disease-associated interstitial lung disease

Bo1 Liang1, Chunyu Zhang2, Yongcai Zheng2, Bing Xu3, Minna Jiang1, Xuegang Zhao1, Xiaomin Liu,1   

  1. 1.Department of Rheumatology and Immunology, Beijing Shunyi District Hospital,Shunyi Teaching Hospital of Capital Medical University, Beijing 101300, China
    2.Department of Ultrasound,Beijing Shunyi District Hospital, Shunyi Teaching Hospital of Capital Medical University, Beijing 101300,China
    3.Department of Radiology,Beijing Shunyi District Hospital,Shunyi Teaching Hospital of Capital Medical University, Beijing 101300, China
  • Received:2024-05-14 Published:2024-12-25
  • Corresponding author: Xiaomin Liu
引用本文:

梁波, 张春雨, 郑永财, 徐冰, 蒋敏娜, 赵学刚, 刘晓敏. 结缔组织疾病相关间质性肺病肺部超声与疾病严重程度的相关性[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(06): 875-881.

Bo1 Liang, Chunyu Zhang, Yongcai Zheng, Bing Xu, Minna Jiang, Xuegang Zhao, Xiaomin Liu. Association of pulmonary ultrasound with disease severity in connective tissue disease-associated interstitial lung disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(06): 875-881.

目的

分析结缔组织疾病相关间质性肺病(connective tissue disease-associated interstitial lung disease,CTD-ILD)肺部超声与疾病严重程度的相关性。

方法

选择2023 年11 月至2024 年1 月我院收治的47 例结缔组织病患者为对象。 根据胸部高分辨CT( high resolution CT,HRCT)结果,CTD-ILD 24 例为观察组和CTD-无ILD 23 例为对照组,采用肺部超声检查,肺功能检查。 分析肺部超声检查结果、肺功能数据、HRCT 间质病变评分等。

结果

观察组肺部超声B 线评分14 肋间25(12,80)分、50 肋间79(37,265) 分、后基底部肋间20(0,30) 分高于对照组14 肋间0(0,0) 分、50 肋间4(0,9) 分、后基底部肋间0(0,3)分(P<0.001)。 50 肋间肺部超声的曲线下面积为0.926(95%CI:0.852 ~0.999,P<0.001),14 肋间肺部超声曲线下面积为0.951(95%CI:0.890 ~1.000,P<0.001),后基底部肋间曲线下面积为0.813(95%CI:0.683~0.942,P<0.001);50 肋间、14 肋间、后基底部肋间肺部超声B 线评分灵敏度分别为83.3%、87.5%、75.0%;50 肋间、14 肋间、后基底部肋间肺部超声B 线评分特异度分别为78.3%、87.0%、73.9%;50 肋间、14 肋间、后基底部肋间肺部超声B 线评分截断值分别>10、>3、>2。 50 肋间、14 肋间、后基底部肋间肺部超声B 线评分阳性预测值分别为87.5%、83.3%、76.2%,阴性预测值分别为78.3%、88.0%、69.2%。 50 肋间、14 肋间及后基底部肋间肺部超声B 线评分与HRCT 间质性肺病半定量评分呈正相关(P<0.001),分别与力肺活量占预计值百分比(FVC/pre)及一氧化碳弥散量占预计值百分比(DLCO/pre)呈负相关(P <0.001)。 观察组胸膜线连续性中断17 例(73.91%)高于对照组4 例(16.67%)(P<0.001)。

结论

肺部超声检查可判断CTD-ILD 严重程度。 14 肋间肺部超声比50 肋间和后基底部肋间肺部超声对CTD-ILD 预测好。

Objective

To analyze the correlation of lung ultrasound with the severity of connective tissue disease-associated interstitial lung disease (CTD-ILD).

Methods

All of 47 patients with connective tissue disease admitted to our hospital from November 2023 to January 2024 were selected.According to the results of high resolution CT (HRCT),24 cases of CTD-ILD were treated as observation group and the other 23 cases of CTD-non ILD were treated as control group.Lung function examination was performed in observation group.The results of pulmonary ultrasound examination,clinical and pulmonary function data,HRCT interstitial lesion score were statistically analyzed.

Results

The ultrasonographic B-line scores of 14 intercostal 25 (12,80),50 intercostal 79(37,265) and posterior basal intercostal 20 (0,30) in the observation group were higher than those of the control group 14 intercostal 0(0,0),50 intercostal 4(0,9) and posterior basal intercostal 0(0,3) (P<0.001).The area under the curve was 0.926 (95%CI:0.852-0.999, P<0.001) of intercostal lung ultrasound 50 and 0.951 (95%CI:0.890-1.000, P<0.001) of intercostal lung ultrasound 14.The area under the posterior basal intercostal curve was 0.813 (95%CI:0.683-0.942, P <0.001).B-line sensitivity of 50 intercostal,14 intercostal and posterior basal intercostal lung ultrasound was 83.3%,87.5%and 75.0%,respectively.The B-line specificity of 50 intercostal lung ultrasound,14 intercostal lung ultrasound and posterior basal intercostal lung ultrasound were 78.3%,87.0% and 73.9%,respectively.The cut-off values of B-line ultrasound score of 50 intercostal,14 intercostal and posterior basal intercostal lung were >10,3 and 2,respectively.The positive predictive values of 50 intercostal,14 intercostal and posterior basal lung ultrasound B-line scores were 87.5%,83.3% and 76.2%,and the negative predictive values were 78.3%,88.0% and 69.2%,respectively.Ultrasonographic B-line scores of 50 intercostal,14 intercostal and posterior basal intercostal lung were positively correlated with HRCT semi-quantitative scores (P<0.001),and negatively correlated with FVC/pre and DLCO/pre,respectively (P<0.001).The incidence of interruption of pleural line continuity was higher in observation group 17 cases(73.91%) than control group 4 cases(16.67%)(P<0.001).

Conclusion

Lung ultrasonography can determine the severity of CTD-ILD.14 intercostal lung ultrasound was better than 50 intercostal and posterior basal intercostal lung ultrasound in predicting CTD-ILD.

表1 两组CTD 患者基线特征结果[( ±s), MQ1,Q3),n(%)]
图1 肺部超声B 线评分及HRCT 间质性肺病半定量评分相关性
图2 肺部超声B 线评分与肺功能相关性
图3 肺部超声预测CTD-ILD 的受试者工作特征曲线
1
Fisseler-Eckhoff A,Marker-Hermann E.Interstitial lung disease associated with connective tissue disease[J].Pathologe,2021,42:4-10.
2
岳欢欢,黎 联.KL-6 和Th1/Th2 细胞因子在结缔组织病相关性间质性肺炎中的表达及临床意义[J/CD].中华肺部疾病杂志(电子版),2020,13(1):18-22.
3
Bruni C,Chung L,Hoffmann-Vold AM,et al.High-resolution computed tomography of the chest for the screening,re-screening and follow-up of systemic sclerosis-associated interstitial lung disease:a EUSTARSCTC survey[J].Clin Exp Rheumatol,2022,40:1951-1955.
4
Pitsidianakis G,Vassalou EE,Vasarmidi E,et al.Performance of lung ultrasound for monitoring interstitial lung disease [ J].J Ultrasound Med,2022,41:1077-1084.
5
Velazquez Guevara BA,Abud Mendoza C,Aviles Ramirez LRJ,et al.Ultrasound for diagnosis of interstitial lung disease in diffuse connective tissue diseases[J].Reumatol Clin (Engl Ed),2023,19:455-462.
6
Yan JH,Pan L,Gao YB,et al.Utility of lung ultrasound to identify interstitial lung disease:An observational study based on the STROBE guidelines [J].Medicine (Baltimore),2021,100:e25217.
7
Moazedi-Fuerst FC,Kielhauser S,Brickmann K,et al.Sonographic assessment of interstitial lung disease in patients with rheumatoid arthritis,systemic sclerosis and systemic lupus erythematosus[J].Clin Exp Rheumatol,2015,33:S87-S91.
8
Barskova T,Gargani L,Guiducci S,et al.Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis[J].Ann Rheum Dis,2013,72:390-395.
9
Mohammadi A,Oshnoei S,Ghasemi-rad M.Comparison of a new,modified lung ultrasonography technique with high-resolution CT in the diagnosis of the alveolo-interstitial syndrome of systemic scleroderma[J].Med Ultrason,2014,16:27-31.
10
Huang S,Guo R,Yuan X,et al.Evaluation of connective tissue disease-related interstitial lung disease using ultrasound elastography:a preliminary study[J].Quant Imaging Med Surg,2022,12:3778-3791.
11
Tardella M,Gutierrez M,Salaffi F,et al.Ultrasound in the assessment of pulmonary fibrosis in connective tissue disorders:correlation with high-resolution computed tomography[J].J Rheumatol,2012,39:1641-1647.
12
Xie HQ,Zhang WW,Sun S,et al.A simplified lung ultrasound for the diagnosis of interstitial lung disease in connective tissue disease:a meta-analysis[J].Arthritis Res Ther,2019,21:93.
13
Gargani L,Romei C,Bruni C,et al.Lung ultrasound B-lines in systemic sclerosis:cut-off values and methodological indications for interstitial lung disease screening[J].Rheumatology (Oxford),2022,61:SI56-SI64.
14
Aletaha D,Neogi T,Silman AJ,et al.2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J].Arthritis Rheum,2010,62:2569-2581.
15
van den Hoogen F,Khanna D,Fransen J,et al.2013 classification criteria for systemic sclerosis:an American college of rheumatology/European league against rheumatism collaborative initiative[J].Ann Rheum Dis,2013,72:1747-1755.
16
Shiboski CH,Shiboski SC,Seror R,et al.2016 American College ofRheumatology/EuropeanLeagueAgainstRheumatism classification criteria for primary Sjogren's syndrome:A consensus and data-driven methodology involving three international patient cohorts[J].Ann Rheum Dis,2017,76:9-16.
17
Lundberg IE,Tjarnlund A,Bottai M,et al.2017 European League AgainstRheumatism/AmericanCollegeofRheumatology Classification Criteria for Adult and Juvenile Idiopathic Inflammatory Myopathies and Their Major Subgroups[J].Arthritis Rheumatol,2017,69:2271-2282.
18
Fischer A,Antoniou KM,Brown KK,et al.An official european respiratory society/american thoracic society research statement:interstitial pneumonia with autoimmune features[J].Eur Respir J,2015,46:976-987.
19
Yazici H,Tascilar K,Yazici Y.2022 american college of rheumatology/european alliance of associations for rheumatology classification criteria sets for three types of antineutrophilic cytoplasmic antibodyassociated vasculitis[J].Curr Opin Rheumatol,2023,35:1-5.
20
Travis WD,Costabel U,Hansell DM,et al.An official American Thoracic Society/European Respiratory Society statement:Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias[J].Am J Respir Crit Care Med,2013,188:733-748.
21
Goldin JG,Lynch DA,Strollo DC,et al.High-resolution CT scan findings in patients with symptomatic scleroderma-related interstitial lung disease[J].Chest,2008,134:358-367.
22
Gutierrez M,Salaffi F,Carotti M,et al.Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders-preliminary results[J].Arthritis Res Ther,2011,13:R134.
23
Gargani L.Lung ultrasound:a new tool for the cardiologist[J].Cardiovasc Ultrasound,2011,9:6.
24
Buda N,Piskunowicz M,Porzezinska M,et al.Lung ultrasonography in the evaluation of interstitial lung disease in systemic connective tissue diseases:criteria and severity of pulmonary fibrosis-analysis of 52 patients[J].Ultraschall Med,2016,37:379-85.
25
Stanojevic S,Kaminsky DA,Miller MR,et al.ERS/ATS technical standard on interpretive strategies for routine lung function tests[J].Eur Respir J,2022,60(1):2101499.
26
Cerro Chiang G,Parimon T.Understanding interstitial lung diseases associated with connective tissue disease (CTD-ILD):genetics,cellular pathophysiology,and biologic drivers[J].Int J Mol Sci,2023,24(3):2405.
27
Kim K,Lee J,Jo YS.Factors for progressive pulmonary fibrosis in connective tissue disease-related interstitial lung disease[J].Ther Adv Respir Dis,2023,17:17534666231212301.
28
Jeon H,Nam BD,Yoon CH,et al.Radiologic approach and progressive exploration of connective tissue disease-related interstitial lung disease:meeting the curiosity of rheumatologists[J].J Rheum Dis,2024,31:3-14.
29
Vicente-Rabaneda EF,Bong DA,Busquets-Perez N,et al.Ultrasound evaluation of interstitial lung disease in rheumatoid arthritis and autoimmune diseases[J].Eur J Rheumatol,2022.
30
Gasperini ML,Gigante A,Iacolare A,et al.The predictive role of lung ultrasound in progression of scleroderma interstitial lung disease[J].Clin Rheumatol,2020,39:119-123.
31
Gutierrez M,Ruta S,Clavijo-Cornejo D,et al.The emerging role of ultrasound in detecting interstitial lung disease in patients with rheumatoid arthritis[J].Joint Bone Spine,2022,89:105407.
32
Manandhar S.Lung ultrasound in diagnosis of interstitial lung disease[J].J Nepal Health Res Counc,2023,20:916-921.
33
Buda N,Wojteczek A,Masiak A,et al.Lung ultrasound in the screening of pulmonary interstitial involvement secondary to systemic connective tissue disease:a prospective pilot study involving 180 patients[J].J Clin Med,2021,10(18):4114.
34
Huang Y,Liu T,Huang S,et al.Screening value of lung ultrasound in connective tissue disease related interstitial lung disease[J].Heart Lung,2023,57:110-116.
35
Mena-Vazquez N,Jimenez-Nunez FG,Godoy-Navarrete FJ,et al.Utility of pulmonary ultrasound to identify interstitial lung disease in patients with rheumatoid arthritis[J].Clin Rheumatol,2021,40:2377-2385.
36
Tardella M,Di Carlo M,Carotti M,et al.Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis:Cut-off point definition for the presence of significant pulmonary fibrosis[J].Medicine (Baltimore),2018,97:e0566.
37
Ferro F,Delle Sedie A.The use of ultrasound for assessing interstitial lung involvement in connective tissue diseases [ J].Clin Exp Rheumatol,2018,36( Suppl 114):165-170.
38
Cottin V,Brown KK.Interstitial lung disease associated with systemic sclerosis (SSc-ILD) [J].Respir Res,2019,20:13.
39
Bruni C,Mattolini L,Tofani L,et al.Lung ultrasound b-lines in the evaluation of the extent of interstitial lung disease in systemic sclerosis[J].Diagnostics (Basel),2022,12(7):1696.
40
Di Battista M,Delle Sedie A,Romei C,et al.Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease[J].Rheumatology (Oxford),2024,63(11):3091-3097.
41
Reyes-Long S,Gutierrez M,Clavijo-Cornejo D,et al.Subclinical interstitial lung disease in patients with systemic sclerosis.a pilot study on the role of ultrasound[J].Reumatol Clin (Engl Ed),2021,17:144-149.
42
Joy GM,Arbiv OA,Wong CK,et al.Prevalence,imaging patterns and risk factors of interstitial lung disease in connective tissue disease:a systematic review and meta-analysis[J].Eur Respir Rev,2023,32(167):220210.
[1] 许玫莎, 王聪, 郑友峰, 吴挺实, 肖成钦, 陈伟. 血浆和肽素联合肺部超声评分及肺血管通透性指数对成人急性呼吸窘迫综合征患者预后预测的临床价值[J/OL]. 中华危重症医学杂志(电子版), 2021, 14(03): 222-225.
[2] 黄毅, 董雪, 郑瑜, 赵洁, 王思翰, 郭晓茹, 于铭. 急诊床边肺部超声改良方案对新型冠状病毒肺炎患者肺部病灶的评估价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2022, 16(03): 150-157.
[3] 韩晓, 汤凤莲, 张友文, 吕高超, 姜波, 王利江. 结缔组织相关性间质性肺病血清S1P 水平与疾病严重程度和免疫抑制治疗的关系[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(06): 869-874.
[4] 杨莎莎, 张毛为, 孙宜田, 刘亚南, 位娟, 魏建, 陈碧. 结缔组织疾病相关间质性肺病并发小气道功能障碍临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 738-743.
[5] 燕红玲, 王岩岩, 陈树斌. PCT、NLR联合LUBS预测ICU CRKP致呼吸机相关肺炎撤机及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 617-620.
[6] 罗霞, 王宝梅, 李淑景, 杨英. 特发性肺动脉高压血清PCSK9表达及预后意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 585-589.
[7] 张黎黎, 杨敏, 石娅妮, 谭红霞. MR-proADM作为社区获得性肺炎预后生物标志物的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(05): 706-708.
[8] 谭烨, 徐盼, 唐喜军, 温赐祥, 于晓勇, 李静. micro RNA-26a与肺部超声评分对重度COPD撤机结局的预测[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(03): 415-417.
[9] 蔡欣诺, 邵思琪, 马华, 周冬梅, 潘彬, 殷松楼. 艾拉莫德通过抑制TNF-α减轻博来霉素诱导的小鼠间质性肺病[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(03): 331-334.
[10] 郑少琴, 杨莎, 胡燕, 田青青. 脓毒性休克并发肺部感染及未分化结缔组织病一例[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(01): 135-137.
[11] 苏姣, 周海艳, 李传芬. 肺部超声评分和CRP对儿童肺炎病情严重程度的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(05): 605-607.
[12] 苗小倩, 张碧玉, 李亚琴, 李小燕, 于清, 卢燕鸣. 超声肺实变在儿童重症社区获得性肺炎中的应用[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(03): 293-296.
[13] 吴志杰, 袁紫旭, 蔡建, 柯嘉, 王辉. 腹膜转移癌诊疗决策中评分系统的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(01): 75-78.
[14] 王亚飞, 吴振彪. 自身抗体在皮肌炎患者管理中的应用[J/OL]. 中华临床医师杂志(电子版), 2022, 16(08): 796-800.
[15] 强光峰, 孟兰兰, 赵静, 牛峰海, 任雪云. 肺部超声评分对呼吸困难新生儿使用有创机械通气的预测价值[J/OL]. 中华诊断学电子杂志, 2023, 11(02): 104-108.
阅读次数
全文
1
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 1

  来源 其他网站
  次数 1
  比例 100%

摘要
17
最新录用 在线预览 正式出版
0 0 17
  来源 本网站 其他网站
  次数 7 10
  比例 41% 59%