结缔组织病相关性肺间质病变的高分辨CT表现

摘要

目的:分析结缔组织病相关性肺间质病变(connective tissue associated interstitial lung disease,CTD-ILD)的高分辨CT(high resolution computed tomography,HRCT)表现.方法:收集中南大学湘雅医院2013年9月至2015年9月结缔组织病患者127例,所有患者均经临床实验室检查或病理学检查确诊为结缔组织病,且HRCT证实存在肺间质病变,回顾性分析患者的肺部HRCT影像表现.结果:127例患者结缔组织病分类包括类风湿关节炎36例(28.3%),皮肌炎及多肌炎34例(26.8%),系统性硬化症31例(24.4%),干燥综合征18例(14.2%),混合性结缔组织病7例(5.5%),系统性红斑狼疮1例(0.8%).根据HRCT表现分为非特异性间质性肺炎(nonspecific interstitial pneumonia,NSIP)77例(60.6%),寻常型间质性肺炎(usual interstitial pneumonia,UIP)46例(36.2%),淋巴细胞性间质性肺炎(lymphocytic interstitial pneumonia,LIP)2例(1.6%),隐源性机化性肺炎(cryptogenic organizing pneumonia,COP)1例(0.8%),急性间质性肺炎(acute interstitial pneumonia,AIP)1例(0.8%).36例类风湿关节炎相关性肺间质病变的HRCT表现为UIP(24例,66.7%)和NSIP(12例,33.3%).34例皮肌炎及多肌炎相关性肺间质病变的HRCT表现为NSIP(32例,94.1%),UIP和COP(各1例,各占2.9%).31例系统性硬化症相关性肺间质病变的HRCT表现为NSIP(21例,67.8%)和UIP(9例,29.0%),LIP(1例,3.2%).18例干燥综合征相关性肺间质病变的HRCT表现为NSIP(9例,50.0%),UIP(8例,44.4%)和LIP(1例,5.6%).7例混合型CTD-ILD的HRCT表现为UIP(4例,57.1%)和NSIP(3例,42.9%).系统性红斑狼疮仅见1例MP.结论:不同类型CTD-ILD的HRCT表现具有相对独特的特点.%Objective:To analyze the features of the connective tissue associated interstitial lung disease (CTD-ILD) by high resolution computed tomography (HRCT).Methods:A total of 127 patients with CTD-ILD,who were diagnosed by clinic laboratory examination and pathology in Xiangya Hospital of Central South University form September 2013 to September 2015,were enrolled for this study.Their lung features of HRCT imaging were retrospectively analyzed.Results:The classifications for 127 patients were as follows:36 cases of rheumatoid arthritis (28.3%),34 cases of dermatomyositis and polymyositis (26.8%),31 cases of systemic sclerosis (24.4%),18 cases of Sj(o)gren syndrome (14.2%),7 cases of mixed connective tissue disease (5.5%),and 1 cases of systemic lupus erythematosus (0.8%).According to the features of HRCT imaging,the patients were divided as follows:77 cases (60.6%) ofnonspecific interstitial pneumonia (NSIP),46 cases (36.2%) of usual interstitial pneumonia (UIP),2 cases (1.6%) of lymphocytic interstitial pneumonia (LIP),1 case (0.8%) of cryptogenic interstitial pneumonia (COP),and 1 case (0.8%) of acute interstitial pneumonia (AIP).The HRCT findings for 36 cases of rheumatoid arthritis associated interstitial lung disease were UIP (24 cases,66.7%) and NSIP (12 cases,33.3%);the HRCT findings for 34 cases of dermatomyositis and polymyositis associated interstitial lung disease were NSIP (32 cases,94.1%),UIP (1 case,2.9%) and COP (1 case,2.9%);the HRCT findings for 31 cases of systemic sclerosis associated interstitial lung disease were NSIP (21 cases,67.8%),UIP.(9 cases,29%),LIP(1 case,3.2%);the HRCT findings for 18 cases of Sj(o)gren syndrome associated interstitial lung disease were NSIP (9 cases,50.0%),UIP (8 cases,44.4%),LIP (1 case,5.6%);the HRCT findings for 7 cases of mixed connective tissue disease associated interstitial lung disease were UIP (4 cases,57.1%),NSIP (3 cases,42.9%).SLE-ILD was rare,with only 1 case of AIP.Conclusion:Different types of CTD-ILD patients display relatively unique manifestation of HRCT.