X线、CT对胶原性疾病致弥漫性肺间质病变的诊断及意义(附13例分析)

The diagnosis and significance of X-ray and CT for diffuse pulmonary interstitial disorders caused by collagenous diseasesanalysis of 13 cases

目的:探讨胶原病致弥漫性肺间质病变的病理演变、影像特点及影像诊断的作用和价值。方法:本组胶原性疾病共13例,男5例,女8例,年龄30～72岁。其中系统性红斑狼疮5例,类风湿、风湿性病变4例,进行性系统性硬化症2例,皮肌炎2例。8例经纤维支气管镜活检,10例做了肺功能检查,13例均做了X线及CT或HRCT检查。结果:胶原性疾病引起机体组织的粘液性水肿、炎性坏死、类纤维蛋白变性和成纤维细胞增生,致广泛的弥漫性肺间质病变。表现为磨玻璃样、片状浸润状、网状、结节状、蜂窝状改变,最终导致肺间质纤维化。结论:胶原性疾病可导致弥漫性肺间质病变。X线、CT检查是诊断本病的重要手段。尤其是HRCT的应用为间质性肺疾病的早期诊断、病变定位、引导肺活检、动态随访等具有重要意义和价值。

Objective To investigate pathological changes radiological features and the roles and value of X-ray diagnosis in diffuse pulmonary interstitial disorders caused by collagenous diseases. Materials and Methods There were 13 cases with collagenous diseases including 5 male cases and 8 female cases. The age ranged from 30 to 72 years old. Among the 13 cases there were 5 cases with SLE 4 cases with rheumatoid and rheumatic disorders 2 cases with progressive systemic sclerosis and 2 cases with dermatomyositis. All the 13 cases had the examinations of X-ray CT or HRCT. And 8 cases had biopsy through fibrobronchial endoscopy. Ten cases had pulmonary function test. Results Collagenous diseases could cause mucosal edema inflammatory necrosis fibrinoid degeneration and fibroblast proliferation in tissues and lead to extensive diffuse pulmonary interstitial disorders. The manifestations were ground glass-like patchy infiltrative net-like nodular and honeycomb-like changes and led to pulmonary interstitial fibrosis eventually. Conclusion Collagenous diseases can lead to diffuse pulmonary interstitial disorders. X-ray and CT are important means for the diagnosis of collagenous diseases especially with the use of HRCT which has important significance and value for early diagnosis orientation guiding pulmonary biopsy dynamic follow-up of interstitial pulmonary diseases.