特发性非特异性间质性肺炎与结缔组织病相关性非特异性间质性肺炎的临床及HRCT比较  

Comparative study of clinical and HRCT findings between idiopathic nonspecific interstitial pneumonia and connective tissue disease-associated nonspecific interstitial pneumonia

作　　者：黎剑宇[1] 邓宇[1] 曾庆思[1] 罗群[2] 邓葵淼 林晓锋[1] 

机构地区：[1]广州医科大学附属第一医院放射科,广州市510120 [2]广州医科大学附属第一医院呼吸科,广州市510120

出　　处：《实用医学杂志》2017年第15期2496-2500,共5页The Journal of Practical Medicine

基　　金：国家卫计委行业专项基金项目资助项目(编号:201402013)

摘　　要：目的探讨特发性非特异性间质性肺炎(INSIP)与结缔组织病相关性非特异性间质性肺炎(CTD-NSIP)的临床和胸部HRCT的不同特点。方法回顾性分析本院近年经临床-病理-影像多学科讨论诊断的73例NSIP患者资料,其中52例为INSIP组,21例为CTD-NSIP组,对两组的临床表现、肺功能测试及胸部HRCT征象进行对比研究。结果 CTD-NSIP组的原发病多为皮肌炎/多发性肌炎、类风湿关节炎、干燥综合征;平均发病年龄CTD-NSIP组[(47.14±9.24)岁]低于INSIP组[(59.09±11.20)岁],差异有统计学意义(P<0.01);INSIP组出现咳痰比例较高,差异具有统计学意义(P=0.02);CTD-NSIP组出现口干/眼干(P=0.021)、关节痛(P=0.007)、皮疹(P=0.001)明显高于INSIP组,差异具有统计学意义;两组肺功能损害均以限制性通气功能障碍伴弥散功能下降为主,组间比较差异无统计学意义(P>0.05);两组HRCT征象中,CTD-NSIP组出现胸膜下垂直线比例小于INSIP组(P=0.005),而出现实变影(P=0.049)、胸膜下线(P=0.004)、胸腔积液(P=0.022)以及食管扩张(P=0.021)比例高于INSIP组,差异具有统计学意义。结论熟悉INSIP和CTD-NSIP在临床及HRCT上相对特征性的表现,有助于两者的鉴别诊断。Objective To investigate the difference in clinical features and chest HRCT findings between idiopathic nonspecific interstitial pneumonia(INSIP)and connective tissue disease-associated nonspecific interstitial pneumonia(CTD-NISP).Methods Totally 73 cases of NISP from 2011 to 2016 were retrospectively reviewed,whose final diagnosis all were made after clinico-radiologic-pathologic discussion and 52 cases of them were diagnosed as INSIP and 21 cases as CTD-NSIP.Clinical features,lung function test results and chest HRCT findings of INSIP and CTD-NSIP were compared.Results Common underlying diseases of CTD-NSIP were poly-/dermatomyositis(PM/DM),rheumatoid arthritis(RA)and Sjogren syndrome(SS).The mean age of CTD-NSIP[(47.14±9.24)y]was younger than that of INSIP[(59.09±11.20)y](P<0.05).Compared to CTD-NSIP,expectoration was more common in patients with INSIP,while dry mouth/eyes,arthralgia and erythra were less common in INSIP(P<0.05).Lung function test 1 showed restrictive ventilatory dysfunction with dispersion function decline was found in both groups.There were no significant differences in lung function test results between INSIP and CTD-NSIP.In HRCT,the subpleural vertical line was more common in INSIP than that in CTD-NSIP,while patchy consolidation,subpleural curvilinear shadow,pleural effusion and esophageal dilation were less common in INSIP(P<0.05).Conclusions Specific difference of clinical and HRCT features between CTD-NSIP and INSIP are conducive to differentiating the two from each other.

关 键 词：特发性非特异性间质性肺炎 结缔组织病相关性非特异性间质性肺炎 临床表现 肺功能测试 HRCT 

分 类 号：R563.1[医药卫生—呼吸系统]