肺高分辨率CT评分对类风湿关节炎相关间质性肺疾病患者预后的分析

摘要

目的 预测RA相关间质性肺疾病(ILD)患者预后不良的因素和胸部高分辨率CT(HRCT)的特点.方法 回顾性分析了2011—2017年在山西省人民医院确诊的130例RA-ILD患者.采用Pearson相关性分析,危险因素分析采用Cox回归分析,确定HRCT上的纤维化评分与生存率的相关性和影响RA-ILD患者预后的危险因素.结果 在平均65个月的随访中,32例(24.6％)患者死亡.Cox单因素分析确定了6个重要的不良预后因素:用力肺活量(FVC)[HR=0.97,95％CI(0.94,0.99);P=0.008],总间质病变得分[HR=1.06,95％CI(1.03,1.08);P<0.01],网格改变得分[HR=1.07,95％CI(1.04,1.09);P<0.01]、牵引性支气管扩张得分[HR=2.04,95％CI(1.21,3.40);P=0.008],纤维化得分[HR=1.07,95％CI(1.01,1.13);P<0.01]和确定的普通型间质性肺炎(UIP)类型[HR=4.18,95％CI(1.40,12.51);P=0.010].在Cox多因素分析中,纤维化评分仍然是一个独立的重要的不良预后因素[HR=8.136,95％CI(2.87,28.35);P=0.001].患者纤维化得分>20％,则患者病死率增加8.136倍.结论 纤维化得分与RA-ILD生存率密切相关.%Objective Idiopathic pulmonary fibrosis, the fibrosis score (i.e., the combined extent of reticulation and honeycombing) is associated with worse survival. The aim of this study was to identify high-resolution computed tomography (HRCT) patterns and patient characteristics that could predict poor prognosis in rheumatoid arthritis-related ILD (RA-ILD). Methods We retrospectively analyzed 130 patients with newly diagnosed RA-ILD from 2011 to 2017 at Shanxi People's Hospital. The Pearson correlation analysis was used for the correlation between the fibrosis score and the worse survival of RA-ILD, and Using Cox regression analysis was used to identify the associations with mortality. A value of P less than 0.05 was considered statistically significant. Results During a median follow-up of 65 months, 32/130 (24.6％) patients died. Univariate analysis identified 6 significant poor prognostic factors: lower baseline ％ predicted forced vital capacity [HR=0.97, 95％CI(0.94, 0.99);P=0.008], total interstitial disease score [HR=1.06, 95％CI(1.03, 1.08);P<0.01], reticulation score [HR=1.07, 95％CI (1.04, 1.09); P<0.01], traction bronchiectasis score [HR=2.04, 95％CI (1.21, 3.40);P=0.008], fibrosis score [HR=1.07, 95％CI (1.01, 1.13);P<0.01], and definite UIP pattern [HR=4.18, 95％CI (1.40, 12.51); P=0.010]. Fibrosis score remained to be an independent significant poor prognostic factor of survival on bivariate analysis [HR=8.136, 95％CI (2.87, 28.35); P=0.001]. Patients with a fibrosis score>20％ had high mortality. Conclusion This study has shown that fibrosis score is strongly associated with worse survival in RA-ILD, and patients with fibrosis score>20％ have a 8.136-fold increased risk of mortality.