肺部超声在结缔组织病相关性间质性肺疾病中的应用价值

Application value of pulmonary ultrasound in connective tissue disease associated with pulmonary interstitial dis⁃ease

目的评估肺部超声对结缔组织病相关性间质性肺疾病(CTD-ILD)的应用价值,探讨其与高分辨CT(HRCT)的诊断一致性。方法选取63例结缔组织病(CTD)患者,根据HRCT检查结果分为ILD组39例和非ILD组24例,两组患者均完成肺部超声检查,记录第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、肺一氧化碳弥散量(DLCO)、肺部超声评分(LUS)以及HRCT的Warrick评分。分析LUS评分与各临床指标的相关性,并比较LUS与HRCT评分在CTD-ILD诊断中的一致性。结果ILD组的肺部超声LUS评分和HRCT的Warrick评分均明显高于非ILD组(t分别=7.67、8.95,P均<0.05),肺功能指标中FEV1、FVC、DLCO明显低于非ILD组(t分别=4.64、9.76、11.06,P均<0.05)。LUS评分与Warrick评分呈正相关(r=0.71,P<0.05),与FEV1、FVC和DLCO均呈负相关(r分别=-0.56、-0.72、-0.60,P均<0.05)。肺部超声LUS评分与HRCT的诊断一致性较高,Kappa值为0.73。结论肺部超声检查可用于CTD患者的长期随诊,可以作为HRCT的辅助检查,有助于早期发现和诊断CTD-ILD。

Objective To evaluate the application value of nodular lung ultrasound in connective tissue disease associated with related to interstitial lung disease(CTD-ILD)and explore its diagnostic consistency with high-resolution CT(HRCT).Methods Sixty-three patients with connective tissue disease(CTD)were selected.According to HRCT results,there were 39 cases in the ILD group and 24 cases in the non-ILD group.Both groups of patients completed lung ultrasonography,and the forced expiratory volume in one second(FEV1),forced vital capacity(FVC),diffusion capacity for carbon monoxide of the lung(DLCO),lung ultrasound score(LUS)and Warrick score of HRCT were recorded.The correlations between LUS score and FEV1,FVC,DLCO,and Warrick score were analyzed.The consistency of LUS and HRCT scores in CTD-ILD diagnosis was analyzed.Results The LUS score and HRCT Warrick score of the ILD group were significantly higher than those of the non-ILD group(t=7.67,8.95,P<0.05),while the FEV1,FVC,and DLCO were significantly lower than those of non-ILD group(t=4.64,9.76,11.06,P<0.05).LUS score was positively related with Warrick score(r=0.71,P<0.05),but negatively related with FEV1,FVC,and DLCO(r=-0.56,-0.72,-0.60,P<0.05).The LUS score and HRCT has a high diagnostic consistency,the Kappa value is 0.73.Conclusion Pulmonary ultrasound can be used for long-term following-up of CTD patients,and can be used as an auxiliary examination of HRCT,which is helpful to early detect and diagnose ILD.