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目的分析系统性硬化症(SSc)肺部受累时胸部高分辨力计算机体层摄影术(HRCT)表现,提高对SSc肺部损害的认识。方法选择2009年1月~2012年6月明确诊断的45例SSc患者,其中男性9例,女性36例;年龄为20~80岁,平均年龄58.50岁。回顾其胸部HRCT表现,并进行HRCT评分,对其胸部HRCT特点进行总结分析。结果胸部HRCT证实,存在间质性肺疾病患者为32例(71.1%),其中34.4%患者(11/32)无呼吸系统症状。SSc肺部受累在HRCT图像上以磨玻璃影(81.3%)和网格影(56.3%)最为常见,分布以双下肺(71.9%)及胸膜下分布(81.3%)为主。对两侧的上中下肺野的HRCT评分进行t检验发现双侧病变差异无统计学意义(P>0.05),呈对称性分布。对上中下肺野的HRCT评分进行两两比较,下肺野受累最明显,中野次之,上野受累最少(P<0.05)。在存在肺间质受累的患者中,弥漫型患者的HRCT评分(8.82±5.56)与局限型患者的评分(8.73±5.61)间差异无统计学意义(P>0.05)。肺外胸部脏器受累包括肺动脉增宽、胸膜病变、心包积液、纵隔淋巴结肿大、食管扩张。肺动脉增宽33.3%(15/45),弥漫型患者中肺动脉增宽的发生率与局限型患者的发生率差异无统计学意义;有雷诺现象者的肺动脉增宽的发生率高(15/34 vs 0/11;P=0.005)。结论胸部HRCT对SSs的肺、胸膜、食道、肺动脉的评估均有较高价值,其中肺间质受累是最为常见的,对称性分布、双下肺突出的间质性病变为其主要特点。
OBJECTIVE: To analyze high-resolution chest computed tomography (HRCT) of patients with systemic sclerosis (SSc) pulmonary involvement and to improve their understanding of SSc lung damage. Methods Forty-five SSc patients with definite diagnosis from January 2009 to June 2012 were selected, including 9 males and 36 females, with a mean age of 58.50 years and 20-80 years old. Reviewing the chest HRCT performance, and HRCT score, summarize the chest HRCT features. Results Chest HRCT confirmed the presence of interstitial lung disease in 32 patients (71.1%), of which 34.4% (11/32) had no respiratory symptoms. Pulmonary involvement of SSc was most common in the HRCT images with ground glass (81.3%) and mesh (56.3%), with double lower lungs (71.9%) and subpleural distributions (81.3%). T-test on both sides of the upper and lower lung field HRCT score showed no significant difference between bilateral lesions (P> 0.05), showing a symmetrical distribution. HRCT scores of the lower middle and lower lung fields were compared with each other, the most obvious involvement of the lower lung field, followed by Nakano, Ueno minimal involvement (P <0.05). In patients with interstitial lung involvement, there was no significant difference between the HRCT score of diffuse patients (8.82 ± 5.56) and the localized patient score (8.73 ± 5.61) (P> 0.05). Extrapulmonary chest organ involvement, including pulmonary artery widening, pleural disease, pericardial effusion, mediastinal lymph nodes, esophageal dilatation. Pulmonary artery widening 33.3% (15/45), diffuse patients with pulmonary artery widened incidence and limited incidence of patients with no significant difference; with Renault phenomenon of pulmonary artery widening the incidence of high (15/34 vs 0/11; P = 0.005). Conclusion Chest HRCT has a high value in the evaluation of lung, pleura, esophagus and pulmonary artery in SSs. Interstitial lung involvement is the most common feature of the SSS. Symmetry distribution and interstitial lesions of the double lower lungs are the main features.