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

doi:10.3877/cma.j.issn.1674-6902.2024.06.005

Abstract

Abstract:

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 DL_CO/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.

Key words: Connective tissue disease, Interstitial lung disease, Lung ultrasound, Disease severity

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]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(06): 875-881.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2024.06.005

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2024/V17/I06/875

Figures/Tables 4

References 42

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.

临床资料	观察组（n=24）	对照组（n=23）	P值
吸烟史	5（20.83）	3（13.04）	0.473
血沉（mm/1 h）	35.83±21.97	27.30±20.77	0.172
C反应蛋白（mg/dl）	0.3（0.1，0.8）	0.3（0.1，0.5）	0.064
肺部超声（分）
B线评分（50肋间）	79（37，265）	4（0，9）	0.000
B线评分（14肋间）	25（12，80）	0（0，0）	0.000
B线评分（基底部肋间）	20（0，30）	0（0，3）	0.000
胸膜线不规则	19（79.17）	14（60.87）	0.173
胸膜线连续性中断	17（73.91）	4（16.67）	0.000
胸膜线毛糙	17（70.83）	10（43.48）	0.053
胸膜线增厚	16（66.67）	9（39.13）	0.051
胸膜线模糊	1（4.17）	1（4.35）	0.974
胸部高分辨CT放射学类型
寻常型间质性肺炎	18（75.00）	0（0.00）	0.000
非特异性间质性肺炎	6（25.00）	0（0.00）

临床资料	观察组（n=24）	对照组（n=23）	P值
吸烟史	5（20.83）	3（13.04）	0.473
血沉（mm/1 h）	35.83±21.97	27.30±20.77	0.172
C反应蛋白（mg/dl）	0.3（0.1，0.8）	0.3（0.1，0.5）	0.064
肺部超声（分）
B线评分（50肋间）	79（37，265）	4（0，9）	0.000
B线评分（14肋间）	25（12，80）	0（0，0）	0.000
B线评分（基底部肋间）	20（0，30）	0（0，3）	0.000
胸膜线不规则	19（79.17）	14（60.87）	0.173
胸膜线连续性中断	17（73.91）	4（16.67）	0.000
胸膜线毛糙	17（70.83）	10（43.48）	0.053
胸膜线增厚	16（66.67）	9（39.13）	0.051
胸膜线模糊	1（4.17）	1（4.35）	0.974
胸部高分辨CT放射学类型
寻常型间质性肺炎	18（75.00）	0（0.00）	0.000
非特异性间质性肺炎	6（25.00）	0（0.00）

[1]	Junmei Song, Yi Wang, Lixue Yin. Assessment of right ventricular systolic function and contractile reserve in patients with connective tissue disease using treadmill exercise stress echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(02): 121-127.
[2]	Zhenhe Li, Changqing Wei, Guodong Zhen, Zhenfu Li. Changes of serum S1P and Wnt5a in patients with sepsis complicating acute respiratory distress syndrome and their clinical significance [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(04): 293-300.
[3]	Yi Huang, Xue Dong, Yu Zheng, Jie Zhao, Sihan Wang, Xiaoru Guo, Ming Yu. Evaluation value of bedside lung ultrasound in emergency-plus for pulmonary lesions in patients with coronavirus disease 2019 [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(03): 150-157.
[4]	Xiao Han, Fenglian Tang, Youwen Zhang, Gaochao Lv, Bo Jiang, Lijiang Wang. Association of serum S1P with disease severity and immunosuppressive therapy in connective tissueassociated interstitial lung disease [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(06): 869-874.
[5]	Shasha Yang, Maowei Zhang, Yitian Sun, Yanan Liu, Juan Wei, Jian Wei, Bi Chen. Clinical analysis of interstitial lung disease associated with connective tissue disease complicated with small airway dysfunction [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(05): 738-743.
[6]	Liya Guo, Yiqing Jiao, Youran Lu, Yanan Wang, Zongxue Zhang, Jian Liu, Yuguang Wang. Analysis of the clinical characteristics of interstitial lung disease complicated by pneumothorax and hystitial diastinum [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 57-62.
[7]	Xinnuo Cai, Siqi Shao, Hua Ma, Dongmei Zhou, Bin Pan, Songlou Yin. Iguratimod decreases bleomycin-induced pulmonary fibrosis in association with inhibition of TNF-α in mice [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(03): 331-334.
[8]	Xiaoqian Miao, Biyu Zhang, Yaqin Li, Xiaoyan Li, Qing Yu, Yanming Lu. Application value of ultrasound lung consolidation in severe community acquired pneumonia in children [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(03): 293-296.
[9]	Fei Li, Chen Zhang, Ruiyu Dou, Jiang Xie. Association of obstructive sleep apnea with the severity of cardiopulmonary impairment in patients with interstitial lung disease [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(02): 146-151.
[10]	Zhao Wang, Jinjie Tian, Zhao Guo, Lei Wang, Hongyan Yan, Sujuan Feng, Yi Zhang. Predictive values of early detection of plasma PGK1 on the severity and prognosis of patients with traumatic brain injury [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(03): 154-159.
[11]	Xuan Song, Xinyan Liu, Daqiang Yang, Maopeng Yang, Bingxin Qin, Shoucheng Tian, Xiuyan Guo, Ziwei Liu, Chunting Wang. Application of lung ultrasound elastography in pulmonary diseases [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(02): 215-219.
[12]	Yafei Wang, Zhenbiao Wu. Application of autoantibodies in management of dermatomyositis patients [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(08): 796-800.
[13]	Bo Jiang, Yansheng Jin, Chun Wang, Kangxing Zhou, Xuebing Feng. Clinical analysis of 263 patients with connective tissue disease-associated pulmonary arterial hypertension [J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(10): 764-768.
[14]	Guangfeng Qiang, Lanlan Meng, Jing Zhao, Fenghai Niu, Xueyun Ren. Predictive value of lung ultrasound scores for the use of invasive mechanical ventilation in neonates with respiratory distress [J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(02): 104-108.
[15]	YinQi Tian, Xuemei Peng. Application progress of lung ultrasound in perioperative respiratory management of obese patients [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(04): 283-286.

Please choose a citation manager

Content to export