绝经后女性结缔组织病相关间质性肺病并骨质疏松的相关性研究

Clinical study on osteoporosis in postmenopausal women with connective tissue disease related interstitial lung disease

目的探讨绝经后结缔组织病相关间质性肺病(connective tissue disease associated interstitial lung disease,CTD-ILD)患者肺部受累与其骨质疏松(osteoporosis,OP)的相关性。方法纳入2018年9月到2023年11月在苏州大学附属第一医院确诊的绝经后CTD-ILD患者,根据患者骨密度(bone mineral density,BMD)结果,分为OP组及非OP组。比较两组患者肺部影像学表现、肺功能与骨量之间的相关性。采用秩和检验、Spearman分析及二元Logistics回归等进行数据分析。结果共纳入绝经后CTD-ILD患者75例,其中OP组35例,非OP组40例。结果表明OP组患者BMD显著低于非OP组,肺功能指标中的通气参数如用力肺活量(forced vital capacity,FVC)、第一秒钟用力呼气容积(forced expiratory volume in one second,FEV_(1))、呼气峰值流量(peak expiratory flow,PEF)、用力呼气50%肺活量时的瞬间流量(maximal expiratory flow in 50%,MEF_(50))及肺总量(total lung capacity,TLC)更差;评分评价患者肺部CT表现,其磨玻璃样结节评分(G评分)和纤维化评分(F评分)得分更高。绝经后CTD-ILD患者BMD与肺功能指标成正相关,与影像学评分成负相关。Logistics回归分析显示,F评分是绝经后CTD-ILD患者合并OP的独立危险因素(P<0.05)。结论绝经后CTD-ILD患者的肺部病变越重,其OP越严重,骨含量越低。

Objective To investigate the correlation between lung involvement and osteoporosis in postmeno-pausal patients with connective tissue disease associated with interstitial lung disease(CTD-ILD).Methods Postmenopausal CTD-ILD patients diagnosed at the First Affiliated Hospital of Soochow University from September 2018 to November 2023 were included.They were divided into the osteoporosis(OP)group and the non OP group based on their bone mineral density(BMD)results.The correlation of lung imaging findings and lung function with bone mass was compared between the two groups.Their clinical data was analyzed by one-way ANOVA,Spearman analysis,and binary Logistics regression.Results A total of 75 postmenopausal CTD-ILD patients were recruited,including 35 cases in the OP group and 40 cases in the non OP group.The results indicated that the BMD in the OP group was significantly lower than that in the non OP group(P<0.05).Ventilation parameters in lung function indicators such as forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),peak expiratory flow(PEF),maximum expiratory flow in 50%(MEF50)and total lung capacity(TLC)were worse.The evaluation of the patient’s lung CT showed higher scores in the ground glass nodule score(G score)and fibrosis score(F score).Postmenopausal CTD-ILD patients had a positive correlation between BMD and lung function indicators,and a negative correlation with imaging scores.Meanwhile,logistic regression analysis showed that patient F score was an independent risk factor for postmenopausal CTD-ILD patients with OP(P<0.05).Conclusion The more severe the lung lesions in postmenopausal patients with CTD-ILD,the more severe their OP,and the lower their bone content.