Kloth Christopher, Maximilian Thaiss Wolfgang, Preibsch Heike, Mark Klemens, Kötter Ina, Hetzel Jürgen, Nikolaou Konstantin, Henes Jörg, Horger Marius
Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen
Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen.
Rheumatology (Oxford). 2016 Oct;55(10):1763-70. doi: 10.1093/rheumatology/kew259. Epub 2016 Jun 21.
The aim of this study was to evaluate the course of SSc-related pulmonary abnormalities following high-dose chemotherapy with autologous stem cell transplantation (SCT) by quantitative chest CT analysis and compare the results with those of pulmonary function tests and the response of cutaneous involvement.
Chest CT quantification was performed before, directly after [0.49 years (sd 0.20)] and at a mean of 2.2 years (sd 2.1) following autologous SCT in 26 consecutive patients with SSc between March 2001 and March 2015. Quantitative CT used fully automated software to calculate inspiratory total lung volume, mean lung density, high attenuation value and their pulmonary distribution (core vs peel). All patients underwent pulmonary function tests. We additionally analysed parallels in the response of associated skin changes by using the modified Rodnan skin score (mRSS).
The forced vital capacity (FVC) course at 6 months was used to classify patients into responders [n = 20 (76.9%)] and non-responders [n = 6 (23.1%)]. FVC, forced expiratory volume in 1 s, vital capacity (VC) as well as single-breath diffusion capacity for carbon monoxide significantly improved (P = 0.03, 0.001, 0.001 and 0.013, respectively) in responders. At quantitative CT, total lung volume increased (P = 0.018), whereas mean lung density (P = 0.026) and high attenuation value decreased (P = 0.020) after autologous SCT in responders. Correspondingly, mRSS improved from 27.35 (sd 9.25) before to 10.81 (sd 8.64) after autologous SCT (P = 0.003) in responders. Changes in mRSS before autologous SCT and thereafter correlated significantly with those 24 months after autologous SCT (r = 0.575; P = 0.031).
CT quantification of lung volume and parenchymal attenuation in SSc patients presenting with alveolitis and fibrosis that undergo autologous SCT yields parameters that match well with those of pulmonary function and even clinical tests. It might therefore be used as a substitute marker in patients who are unable to adequately perform lung function tests.
本研究旨在通过胸部CT定量分析评估自体干细胞移植（SCT）大剂量化疗后系统性硬化症（SSc）相关肺部异常的病程，并将结果与肺功能测试结果及皮肤受累反应进行比较。
对2001年3月至2015年3月期间连续26例SSc患者在自体SCT前、术后即刻[0.49年（标准差0.20）]及平均2.2年（标准差2.1）时进行胸部CT定量分析。定量CT使用全自动软件计算吸气末肺总量、平均肺密度、高衰减值及其肺部分布（核心区与周边区）。所有患者均接受肺功能测试。我们还通过改良Rodnan皮肤评分（mRSS）分析相关皮肤变化反应的平行情况。
以6个月时的用力肺活量（FVC）病程将患者分为反应者[n = 20（76.9%）]和无反应者[n = 6（23.1%）]。反应者的FVC、第1秒用力呼气容积、肺活量（VC）以及一氧化碳单次呼吸扩散能力均显著改善（分别为P = 0.03、0.001、0.001和0.013）。在定量CT方面，反应者自体SCT后肺总量增加（P = 0.018），而平均肺密度（P = 0.026）和高衰减值降低（P = 0.020）。相应地，反应者自体SCT后mRSS从术前的27.35（标准差9.25）改善至术后的10.81（标准差8.64）（P = 0.003）。自体SCT前后mRSS的变化与自体SCT后24个月的变化显著相关（r = 0.575；P = 0.031）。
对患有肺泡炎和纤维化且接受自体SCT的SSc患者进行肺容积和实质衰减的CT定量分析所得到的参数，与肺功能甚至临床试验参数匹配良好。因此，它可作为无法充分进行肺功能测试患者的替代指标。
