HRCT对类风湿性关节炎早期肺损害的诊断价值

The early pulmonary involvement in RA assessment with HRCT

目的 :研究胸片正常的类风湿关节炎患者早期肺损害在HRCT上的影像学表现 ,探讨HRCT对类风湿关节炎早期肺损害的诊断价值 ,及其与临床肺功能检查的相关性。方法 :对 2 4例临床诊断为类风湿关节炎且无吸烟史的患者 ,进行临床体检、普通X线胸片、HRCT扫描及临床肺功能检查 ,剔除 4例胸片有明显征象与类风湿无关的患者。结果 :2 0名患者CT扫描发现 1 4例 (70 %)肺部有间质性病变 ,其中为小叶间隔增厚 1 1例 (5 7%) ,气管壁增厚及其牵拉性支气管扩张 6例(43%) ,胸膜肥厚 5例 (36 %) ,壁胸膜肥厚粘连 4例 (2 9%) ,长瘢痕线 1例 (7%) ,胸部小结节影 2例 (1 4 %) ,磨玻璃样改变 2例 (1 4 %) ,蜂窝样改变 1例 (7%)。 6例 (30 %)患者无肺间质改变。 1 4例患者HRCT异常的患者中有 7例 (5 0 %)有临床肺功能损害 ,6名HRCT显示正常的患者中有 2名 (33%)有肺功能损害。结论 :类风湿性关节炎患者早期病变细微而胸片正常 ,HRCT检查常有异常 ,但与临床肺功能检查结果相关性较差 ,小叶间隔增厚与气管壁增厚牵拉性支气管扩张及胸膜肥厚是类风湿性关节炎累及肺最常见的表现 ,HRCT对类风湿早期肺损害的诊断意义是有限的。

Objective:To determine the frequency and distribution of early pulmonary lesions in patients with rheumatoid arthritis(RA) and a normal chest X-ray on HRCT,and to correlate the CT findings with the clinical pulmonary function test.Methods:24 patients were proven RA with no history of smoking underwent clinical examination chest X-ray HRCT and pulmonary function test.4 were excluded with obvious signs unrelated with RA.Results:14 of 20patients(70%) have abnormality on HRCT.Interlobular septa thickening 7 cases,Bronchial wall thickening and brochial dilation 6 cases,pleural thickening 5 cases,long scar line 1 case,micronodules 2 cases,ground glasses opacity 1 case,honey combing 1 case.6 patients normal.Conclusion:patients with RA but a normal chest radiography frequently abnormal with HRCT.Interlobular thickening brochial thickening and pleural thickening were most seen.As these abnormalities are subtle and there extent does not correlate with the pulmonary function test data.the overall routine HRCT test on RA is limited.