间质性肺疾病肺超声表现与心脏受累程度之间的相关性研究

Reasearch on correlation between lung ultrasound findings of interstitial lung diseases and cardiac involvement

目的应用心肺联合超声评估间质性肺疾病患者心肺改变，明确肺超声表现与心脏受累程度（肺动脉收缩压、右心功能）之间的联系。方法收集本院呼吸科确诊为间质性肺疾病住院患者72例，住院期间行心肺联合超声检查，采集常规超声心动图指标包括肺动脉收缩压（PASP）、三尖瓣反流面积（ATR）、肺动脉主干（DMPA）及左右分支（DLPA/DRPA）内径、右室流出道近端及远端内径（DRVOT1/DRVOT2）、右室横径及中部内径（RVTD/RVDm）、三尖瓣环收缩期位移（TAPSE）、左室射血分数（LVEF）、左室舒张末期内径（LVEDd）；组织多普勒指标包括三尖瓣环峰值运动速度（S′/e′/a′）、Tei指数；二维斑点追踪超声心动图指标为右室整体长轴应变（RV GLS）。肺超声评估包括B线数目及胸膜线表现。对以上超声参数进行统计学分析。结果①以PASP＝36 mmHg为界，分为肺动脉高压（PH）组与非PH组。两组超声心动图参数比较，ATR、RVD、RVDm、RPA、RVGLS、Tei指数、FAC等参数的差异均存在统计学意义，（P〈0.05）。两组肺超声参数比较，B线数目、胸膜线分度的差异存在统计学意义（P〈0.05）。②以胸膜线分度分组，分为重度组和轻中度组，两组超声心动图参数比较，仅ATR、RPA及RVGLS的差异存在统计学意义（P〈0.05）。③B线数目与PASP相关性最好（r＝0.547），胸膜线分度与PASP、RVGLS存在弱相关。④B线条数诊断肺动脉压力升高的临界值为35条，灵敏度和特异度分别为95.8%和37.5%，曲线下面积为0.707（P〈0.05）。结论心肺联合超声能够有效评估间质性肺疾病患者心肺情况；间质性肺疾病发展至一定程度右心结构、功能将出现不同程度受损；肺超声在评价间质性肺疾病肺部改变的基础上，间接反映PASP、右心功能变化，联合超声心动图可为临床提供更多有用信息。

Objective To assess the relationship between lung ultrasonography and cardiac involvement （pulmonary artery systolic pressure, right ventricular function） in patients with interstitial lung diseases（ILD） by integrative cardiopulmonary ultrasound （also called thoracic ultrasound, TUS）. Methods Seventy two patients with clinically diagnosed ILD were investigated at the Department of Respiratory Medicine in our hospital. The tranditional echocardiographic parameter included pulmonary arterial systolic pressure（ PASP）, tricuspid regurgitation area（ ATR ）, main pulmonary artery diameter（DMPA ）, left pulmonary artery diameter （DLpA）, right pulmonary artery diameter（DRvA ）, right ventricular outflow tract dimensions at the proximal or subvalvular level （DRvtm）, right ventricular outflow tract dimensions at the distal or pulmonic valve（DRVOT2 ）, right ventricular basal diameter（RVTD）, mid-right-ventricular diameter（RVDm）, tricuspid annular plane systolic excursion （TAPSE）, left ventricular ejection fraction （LVEF） and left ventricular end- diastolic diameter （LVEDd）. Tissue Doppler parameters includpeak velocity of tricuspid annulus （S＇, e＇, a＇） and myocardial performance index（MPI）;Two dimensional speckle tracking imaging （2D-STI） parameter was right ventricular global strain （RVGLS）. The number of B lines and the performance of pleural line were evaluated by lung ultrasound. Statistical analysis was performed on the above TUS indexes. Results （1）With the use of PASP higher than 36mmHg as the criterion for pulmonary hypertension（PH）, all patients were divided into group ILDpH and group ILDNpH, comparison of TUS parameters in two groups, several parameters had statistical difference including ATe, RVD, RVDm, RPA, RVGLS, MPI, FAC, the number of B lines and the grade of pleural line. （2）According to the degree of pleural involvement, all patients were divided into severe group and mild moderate group, in the comparison of echocardiographic parameters, only Ara, RPA and RVGLS had statistic difference. （3） A positive correlation was found between the number of B lines and PASP（ r = 0. 547）, a weak correlation was found between the grade of pleura line and PASP or RVGLS. （4）A cut off more than 35 B lines had 95.8% sensitivity, 37.50% specificity in predicting elevated PASP（〉36 mmHg）, and the area under the ROC curve was 0.707. Conclusions TUS can effectively assess ILDs. With the disease progresess, the structure or function of right ventricular will gradually damaged. Lung ultrasound can not only evaluate the changes of lung in ILD, but also indirectly reflect PASP and the function of right ventricle, and it combined with echocardiography can provide more useful information for clinical diagnosis and management of ILDs.