系统性硬皮病患者的间质性肺病:预测病变体积的方法

D. V. Khorolsky, A. Klimenko, E. Pershina, N. Babadaeva, A. Kondrashov, N. Shostak, E. P. Mikheeva, M. P. Mezenova, E. Zhilyaev
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引用次数: 0

摘要

目的:确定有助于预测系统性硬皮病(SSc)患者肺部病变体积的因素。确定有助于预测系统性硬皮病(SSc)患者肺部病变体积的因素。分析对象包括肌炎、系统性硬化症和混合结缔组织病(REMISSIS)登记处观察到的 SSc 患者,他们都接受了肺部高分辨率计算机断层扫描(HRCT)。在免疫学特征方面,对所有患者进行了抗拓扑异构酶(抗Scl-70)、抗中心粒(抗CENP-B)抗体和抗中心粒抗体(抗Pm-Scl)检测。研究共纳入 79 名 SSc 患者。女性占 94.9%。平均年龄为(64.4 ± 11.5)岁。根据 HRCT 检测,50 名患者出现了间质性肺病(ILD)症状。无硬皮病SSc患者的肺损伤程度最大(32.7 ± 29.3 %),弥漫型SSc患者的肺损伤程度较小(16.9 ± 17.1 %),局限型SSc患者的肺损伤程度最低(8.5 ± 14.2 %)。除疾病类型外,据统计,伴有关节痛、呼吸困难以及存在拓扑异构酶 I 抗体和合并自身抗体的 SSc-ILD 患者的肺损伤程度明显更高。此外,6分钟步行和用力肺活量测试的所有指标在统计学上都有明显的反馈作用,与肺动脉收缩压指标也有直接关系。在根据博格标准评估肺损伤程度与呼吸困难程度之间的相关性时发现,在呼吸困难评估低于 3 分的患者中,肺损伤程度低于 25%。由于两者高度相关,因此建立了肺损伤程度与 6 分钟步行测试距离的回归公式:肺损伤程度 = (52.7-0.1) × 6MWT 距离。此外,还得出了预测 SSc 肺损伤程度的多变量模型,其中患者的免疫类型、6 分钟步行测试距离、6 分钟步行测试后的饱和度以及是否存在呼吸困难最为有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interstitial lung disease in patients with systemic scleroderma: approaches to predicting lesion volume
Aim. To determine the factors that contribute to the prediction of the volume of pulmonary lesion in patients with systemic scleroderma (SSc).Materials and methods. The analysis included patients with SSc observed in the Registry of Myositis, systemic sclerosis and mixed connective tissue disease (REMISSIS), who underwent high-resolution computed tomography (HRCT) of the lungs. For the immunological characteristic, all patients were tested for anti-topoisomerase (anti-Scl-70), and anti-centromeric (anti-CENP-B) antibodies, and anticentromere antibodies (anti-Pm-Scl).Results. The study included 79 patients with SSc. There was 94.9 % women. Average age – 64.4 ± 11.5 years. Signs of interstitial lung disease (ILD), according to HRCT were detected in 50 patients. The largest extent of lung injury was noted in patients with SSc sine scleroderma (32.7 ± 29.3 %), a smaller extent in patients with diffuse form SSc (16.9 ± 17.1 %) and the lowest in patients with limited SSc (8.5 ± 14.2 %). In addition to the type of disease, the extent of lung injury in patients with SSc-ILD was statistically significantly higher in patients with arthralgia, dyspnea and the presence of antibodies to topoisomerase I and combined autoantibodies. Also, a statistically significant feedback was established with all indicators of the test with a 6-minute walk and forced vital capacity and a direct relationship with indicators of pulmonary artery systolic pressure. When evaluating the correlation between the extent of lung injury and the degree of dyspnea according to Borg, it was found that in patients who assessed dyspnea less than 3 points, the extent of lung injury was less than 25 %. Due to the high degree of correlation, a regression formula was created for the dependence of the extent of lung injury on the distance in the test with a 6-minute walk: extent of lung injury = (52.7–0.1) × distance 6MWT. A multivariate model was also obtained for predicting the extent of lung injury in SSc, in which the patient’s immunotype, distance in the 6-minute walk test, saturation after the 6-minute walk test, and the presence of dyspnea became the most effective.
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