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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2024年06期

页码:

875-881

栏目:

论著

出版日期:

2024-12-25

文章信息/Info

Title:

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

作者:

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

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¹
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²
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³

Author(s):

Liang Bo¹;  Zhang Chunyu²;  Zheng Yongcai²;  Xu Bing³;  Jiang Minna¹;  Zhao Xuegang¹;  Liu Xiaomin¹.

¹Department of Rheumatology and Immunology, Beijing Shunyi District Hospital, Shunyi Teaching Hospital of Capital Medical University, Beijing 101300, China; ²Department of Ultrasound, Beijing Shunyi District Hospital, Shunyi Teaching Hospital of Capital Medical University, Beijing 101300, China; ³Department of Radiology, Beijing Shunyi District Hospital, Shunyi Teaching Hospital of Capital Medical University, Beijing 101300, China

关键词:

结缔组织病;  间质性肺病;  肺部超声;  疾病严重程度

Keywords:

Connective tissue disease;  Interstitial lung disease;  Lung ultrasound;  Disease severity

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2024.06.005

摘要:

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(DL_CO/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。

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.

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备注/Memo

备注/Memo:

基金项目: 北京市顺义区医院科研发展专项基金资助项目(顺医2023Z03)
通信作者: 刘晓敏, Email: lxm101300@163.com

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更新日期/Last Update: 2024-12-25