抗合成酶综合征相关间质性肺炎肺部高分辨CT特点分析

High-resolution CT imaging features of lung in anti-synthetase syndrome patients complicated with interstitial lung disease

目的:探讨不同亚型抗合成酶综合征间质性肺炎(ASS-ILD)肺部高分辨CT(HRCT)特点,指导临床治疗。方法:回顾分析60例ASS-ILD患者临床及影像资料。根据肺部HRCT模式分为4组:NSIP、OP、NSIP-OP、AIP,根据CT随访结果将间质性肺炎(ILD)的结局分为3类:好转、稳定、恶化。结果:60例患者肺部HRCT表现为NSIP者35例,OP者8例,NSIP-OP者10例,AIP者7例;结局好转23例,稳定25例,恶化12例,不同影像学模式和不同亚型、ASS-ILD患者结局差异均无统计学意义(P>0.05)。结论:不同ASS-ILD肺部HRCT模式NSIP最常见,但NSIP患者多数表现为好转和稳定,恶化者可能进入纤维化期,对免疫治疗应答不佳。OP和NSIP-OP患者多数结局好转、稳定,对糖皮质激素应答良好。

Objective:To investigate high-resolution CT(HRCT)imaging features of lung in patients with different subtypes of anti-synthetase syndrome complicated with interstitial lung disease(ASS-ILD)and provide guidance for treatment.Methods:The clinical and imaging data of 60 patients with ASS-ILD were retrospectively analyzed.According to HRCT imaging features,these cases were divided into four groups,nonspecific interstitial pneumonia(NSIP),organizing pneumonia(OP),NSIP/OP and acute interstitial pneumonia(AIP).Based on follow-up CT examination,the outcomes of ILD included three categories,the improved,the stabilized and the deteriorated.Results:According to HRCT findings,NSIP,OP,NSIP/OP and AIP were found in 35,8,10 and 7 patients respectively.As for the outcomes,there were 23 improved,25 stabilized and 12 deteriorated cases respectively.There was no significant difference in the outcomes of ILD patients with different HRCT manifestations and subtypes(P>0.05).Conclusion:NSIP is the most common subtype of ASS-ILD.However,the outcomes of most NSIP patients are improved or stabilized.Pulmonary fibrosis is observed in patients with deteriorated outcomes and they have poor response to immunotherapy.The outcomes of most OP and NSIP/OP patients are improved or stabilized,and they respond well to glucocorticoids.