高分辨率CT对结缔组织病间质性肺病的病情评估价值及与抗核抗体异常的关系

Assessment value of HRCT for the condition of CTD-ILD and its relationship with abnormal ANA

目的:探讨高分辨率CT(HRCT)对结缔组织病(CTD)合并间质性肺病(ILD)患者的病情评估价值及与抗核抗体(ANA)异常的关系。方法:收集2020年1月至2023年6月亳州市人民医院风湿免疫科住院的60例CTD-ILD患者资料,根据ANA检测是否阳性将其分为ANA阳性组(33例)和ANA阴性组(27例),所有患者均行HRCT检查和ANA水平检测,并进行肺功能评估获得肺部HRCT评分。采用受试者工作特征(ROC)曲线分析肺部HRCT评分对CTD-ILD的诊断价值,采用Spearman相关性分析评估CTD患者并发ILD与ANA水平异常的相关性。结果:60例CTD患者中小叶间隔增厚29例,毛玻璃样变25例,网格影13例,支气管血管束增厚10例,蜂窝肺、结节灶均为6例,马赛克灌注5例,肺实变3例;不同HRCT影像特征的CTDILD患者的ANA水平和肺部HRCT评分比较,差异有统计学意义(F=7.115、178.080,P<0.05),且ANA水平从高到底依次为肺实变、蜂窝肺、马赛克灌注、毛玻璃样变、支气管血管束增厚、网格影、结节灶及小叶间隔增厚;ANA阳性组平均肺部HRCT评分[(4.67±1.02)分、ANA水平(60.14±10.01)units]明显高于ANA阴性组[(2.12±1.03)分、ANA水平(7.13±1.13)units],差异有统计学意义(t=23.753、27.333,P<0.05);肺部HRCT评分、ANA单独及两者联合诊断CTDILD的ROC曲线下面积(AUC)分别为0.765、0.618和0.797,均>0.5,且肺部HRCT评分和联合诊断AUC均在0.7~0.9之间;Spearman相关性分析结果显示,肺部HRCT评分与ANA之间存在正相关关系(r=0.463,P<0.001)。结论:通过HRCT检查并进行肺部HRCT评分有助于评估CTD-ILD的病情,肺部HRCT评分越高,CTD-ILD病情越严重,ANA水平异常程度越高,肺部HRCT评分与ANA异常存在正相关关系。

Objective:To investigate assessment value of high-resolution computed tomography(HRCT)for the condition of patients with connective tissue disease(CTD)combined with interstitial lung disease(ILD)and its relationship with the abnormalities of antinuclear antibody(ANA).Methods:A total of 60 CTD-ILD patients who hospitalized in the Department of Rheumatology of the People's Hospital of Bozhou from January 2020 to June 2023 were collected,and they were divided into positive ANA group(33 cases)and negative ANA group(27 cases)according to whether ANA was positivity.All patients underwent HRCT examination and ANA level test,and the lung HRCT scores of them were obtained by lung function assessment.The receiver operating characteristic(ROC)curve was adopted to analyze the diagnostic value of lung HRCT score for CTD-ILD,and Spearman correlation analysis was adopted to assess the correlation between the complicated ILD and the abnormality of ANA level in patients with CTD.Results:In 60 CTD patients,29 cases had interlobular septal thickening,and 25 cases had ground-glass-like change,and 13 cases existed grid shadow,and 10 cases had bronchial vascular bundle thickening,and patients with the honeycomb lung and who with nodular foci were all 6 cases,and 5 cases had mosaic infusion,and 3 cases had lung consolidation.There were significant differences in ANA level and HRCT score of lung among different patients with different characteristics of HRCT images(F=7.115,178.080,P<0.05),respectively.In addition,the order of ANA levels from high to low was lung consolidation,honeycomb lung,mosaic perfusion,ground-glass-like change,bronchial vascular bundle thickening,grid shadow,nodular foci and interlobular septal thickening.Lung HRCT score[(4.67±1.02),ANA level(60.14±10.01)units]of positive ANA group were significantly higher than that[(2.12±1.03),ANA level(7.13±1.13)]of negative ANA group,and the difference was statistically significant(t=23.753,27.333,P<0.05).The area under curve(AUC)of ROC curve of lung HRCT score,ANA alone and the combination of them were 0.765,0.618 and 0.797 in diagnosing CTD-ILD,respectively,and all of them were>0.5,and the AUC values of lung HRCT score and the combined diagnosis were between 0.7-0.9.The results of the Spearman-correlation analysis showed that there was a positive correlation between lung HRCT score and ANA(r=0.463,P<0.001).Conclusion:The HRCT examination and lung HRCT score are helpful to assess the CTD-ILD condition,and patient with higher lung HRCT score has more severe CTD-ILD condition and higher abnormality of ANA.There is a positive correlation between lung HRCT score and ANA abnormality.