Kon O M, Daniil Z, Black C M, du Bois R M
Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.
Eur Respir J. 1999 Jan;13(1):133-6. doi: 10.1183/09031936.99.13113399.
This study evaluated the utility of the clearance time of inhaled diethylenetriamine pentaacetate (DTPA) to distinguish pulmonary vascular disease from early fibrosing alveolitis (FA) in patients with systemic sclerosis (SSc). It was hypothesized that this would be preserved in patients with vascular disease compared with FA, despite similar gas-transfer deficits and matching lung volumes, because of the preservation of alveolar epithelial integrity. All patients had SSc and were categorized into a control group (C; n=9), pulmonary vascular group (VAS; n=14) or FA group (n=14) dependent on the appearance on a computed tomography (CT) scan and the transfer factor of the lung for carbon monoxide (T(L,CO)) (VAS and FA < or =70%, C > or =80%). All patients had a forced vital capacity (FVC) of >80%. The T(L,CO) (median) was similar in the VAS (57.5%) and FA (60%) groups. There was a significant difference in median DTPA clearance half-times between FA (21.25 min) and VAS (46.5 min) (p=0.014) and between FA and C (84.5 min) (p=0.0004). No difference was found between VAS and C (p=0.0778). Follow-up data from the VAS group showed no subsequent development of FA on the CT scan and no decrease in FVC (n=13, mean 42 months). These results suggest that clearance of diethylenetriamine pentaacetate is preserved in patients likely to have pulmonary vascular disease and may be useful in distinguishing fibrosing alveolitis from vascular disease in systemic sclerosis.
本研究评估了吸入二乙烯三胺五乙酸（DTPA）清除时间在系统性硬化症（SSc）患者中区分肺血管疾病与早期纤维化肺泡炎（FA）的效用。研究假设，尽管气体交换缺陷和肺容积匹配相似，但由于肺泡上皮完整性得以保留，与FA患者相比，血管疾病患者的这一指标将得以保留。所有患者均患有SSc，根据计算机断层扫描（CT）结果及一氧化碳肺转运因子（T(L,CO)）（血管组和纤维化肺泡炎组≤70%，对照组≥80%）分为对照组（C；n = 9）、肺血管组（VAS；n = 14）或纤维化肺泡炎组（n = 14）。所有患者的用力肺活量（FVC）均>80%。VAS组（57.5%）和纤维化肺泡炎组（60%）的T(L,CO)（中位数）相似。纤维化肺泡炎组（21.25分钟）与血管组（46.5分钟）之间（p = 0.014）以及纤维化肺泡炎组与对照组（84.5分钟）之间（p = 0.0004）的DTPA清除半衰期中位数存在显著差异。血管组与对照组之间未发现差异（p = 0.0778）。血管组的随访数据显示，CT扫描未出现后续的纤维化肺泡炎进展，FVC也未降低（n = 13，平均42个月）。这些结果表明，二乙烯三胺五乙酸清除率在可能患有肺血管疾病的患者中得以保留，可能有助于在系统性硬化症中区分纤维化肺泡炎与血管疾病。
