结缔组织病肺间质病变影像与病理类型的相关性研究  

Correlation between Imaging Features of High-resolution computed tomography and histopathology of connective tissue diseases associated interstitial lung diseases

作　　者：张光峰 刘倩[2] 林浩博 吴超琛 赵振军[3] 张晓 

机构地区：[1]广东省人民医院/广东省医学科学院风湿科广州510080 [2]武汉大学人民医院汉川医院风湿科,湖北汉川432300 [3]广东省人民医院/广东省医学科学院放射科广州510080

出　　处：《重庆医学》2017年第A03期12-16,共5页Chongqing medicine

摘　　要：目的分析不同结缔组织病相关肺间质病变（CTD-ILD）的影像特征与组织病理学分型的相关性，探讨从影像类型推断病理分型的可行性。方法从2008年11月至2014年6月广东省人民医院收治的2320例诊断为结缔组织病的患者中筛选CTD-ILD患者325例，回顾性分析325例患者的临床资料及高分辨计算机体层成像；其中43例经皮肺穿刺活检获得肺间质病变病理分型资料，对照其HRCT影像特征及类型，着重分析影像分型与肺组织病理类型的相关性。结果CTD-ILD平均发病率高达14％，在SSc／RA-ILD中HRCT影像征象是以蜂窝和网格影为主，归为NSIP和UIP影像类型组；在DM-ILD中以网格影较多见，在PM／SLE-ILD中以实变影多见，而pSS-ILD患者无倾向的影像特点根据HRCT上影像表现聚集不同将325例CTD-ILD患者在分为3型，其中UIP型76例，NSIP型121例，未定型128例。UIP、NSIP型多见于SSc患者，而SLE／PM_ILD很少出现UIP、NSIP影像类型；43例行肺活检患者CTD-ILD病理诊断UIP20例，NSIP20例，未分型3例，统计ILD病理分型和影像类型的匹配关系发现，2种分型方法的相关吻合度良好，差异有统计学意义（P〈0．05）。结论CTD-ILD影像类型与病理分型之间具有良好的吻合度，临床可以通过HRCT特点间接推断ILD的病理分型。Objective By analysis the correlation between images of high-resolution computed tomography （HRCT） and histopathology patterns of different connective tissue diseases associated interstitial lung diseases（CTD-ILDs）,we aimed to investigate the feasibility of deduce the histopathology pattern from HRCT imaging and thereby avoid lung biopsy in such patients. Methods Patients with a diagnosis of CTD in Guangdong General Hospital from November 2008 to June 2014 were screened and those with a diagnosis of ILD were enrolled in this study. The clinical data and findings on HRCT of those patients were reviewed;histopathology patterns of lung biopsy samples from 43 patients obtained by CT guided percutaneously transthoracic approaches were analyzed and compared with their HRCT images. Results 2 320 patients were screened and 325 of those were enrolled. Three major imaging patterns were identified： usual interstitial pneumonia（UIP, 76 patients）, non-specific interstitial pneumonia （NSIP, 121 patients） and indeterminate （128 patients）. UIP and NSIP were more common in SSc-ILD patients,and rarely in SLE/PM-ILD patients. Histopathology patterns from 43 lung biopsies could also be divided to three types;UIP（20 samples）,NSIP（20 samples）, undefined（3 sampies）. Statistical analysis showed positive correlation between histopathology patterns and imaging features on HRCT in CTD-ILD patients （P〈0.05）. Conclusion Since there was a very good correlation between HRCT imaging findings and histopathology results, HRCT features of those patients with CTD may be a good indication ofILD and may avoid lung biopsy in those patients.

关 键 词：结缔组织病 肺间质病变 高分辨CT 病理类型 

分 类 号：R714.22[医药卫生—妇产科学]