Vasco Pablo Guisado, de Luna Cardenal Gonzalo, Garrido Isabel Martín, Pinilla José Manuel Luque, Rodríguez Guadalupe Fraile, Mateo Juan José Nava, Ruiz Daniel Carnevalli
Internal Medicine Department, Complejo Hospitalario Ruber Juan Bravo, European University, Juan Bravo Street 39-49, 28006, Madrid, Spain.
Médecine Interne, Hôpital Européen Georges-Pompideu, 20 Rue Leblanc, 75015, Paris, France.
Intern Emerg Med. 2017 Apr;12(3):327-331. doi: 10.1007/s11739-016-1582-8. Epub 2016 Nov 29.
The background of this study is to assess the accuracy of lung ultrasound (LUS) to diagnose interstitial lung disease (ILD) in Sjögren's syndrome (Sjs), in patients who have any alterations in pulmonary function tests (PFT) or respiratory symptoms. LUS was correlated with chest tomography (hrCT), considering it as the imaging gold standard technique to diagnose ILD. This is a pilot, multicenter, cross-sectional, and consecutive-case study. The inclusion criteria are ≥18 years old, Signs and symptoms: according to ACEG 2002 criteria, respiratory symptoms (dyspnea, cough), or any alterations in PFR. LUS was done following the International Consensus Conference on Lung Ultrasound protocol for interstitial syndrome (B pattern). Of the 50 patients in follow-up, 13 (26%) met the inclusion criteria. All were women with age 63.62 years (range 39-88). 78.6% of the cases had primary Sjs (SLE, RA, n = 2). The intra-rater reliability k is 1, according to Gwet's Ac1 and GI index (probability to concordance-e(K)-, by Cohen, of 0.52). LUS has a sensitivity of 1 (95% CI 0.398-1.0), specificity of 0.89 (95% CI 0.518-0.997), and a positive probability reason of 9.00 (95% CI 7.1-11.3) to detect ILD. The correlation of Pearson is r = 0.84 (p < 0.001). To check the accuracy of LUS to diagnose ILD, a completely bilateral criterion of yes/no for interstitial pattern was chosen, AUC reaches significance, 0.94 (0.07) (95% CI 0.81-1.0, p = 0.014). LUS reaches an excellent correlation to hrCT in Sjs affected with ILD, and might be a useful technique in daily clinical practice for the assessment of pulmonary disease in the sicca syndrome.
本研究的背景是评估肺部超声（LUS）在干燥综合征（Sjs）患者中诊断间质性肺疾病（ILD）的准确性，这些患者的肺功能测试（PFT）或呼吸系统症状有任何改变。将LUS与胸部断层扫描（hrCT）进行相关性分析，将其视为诊断ILD的影像学金标准技术。这是一项试点、多中心、横断面和连续病例研究。纳入标准为年龄≥18岁，体征和症状：根据ACEG 2002标准，有呼吸系统症状（呼吸困难、咳嗽）或PFR有任何改变。LUS按照国际间质性综合征肺部超声共识会议方案（B型）进行。在50例随访患者中，13例（26%）符合纳入标准。所有患者均为女性，年龄63.62岁（范围39 - 88岁）。78.6%的病例为原发性Sjs（SLE、RA，n = 2）。根据Gwet的Ac1和GI指数，评估者内信度k为1（一致性概率-e(K)-，由Cohen计算，为0.52）。LUS检测ILD的敏感性为1（95%CI 0.398 - 1.0），特异性为0.89（95%CI 0.518 - 0.997），阳性概率比为9.00（95%CI 7.1 - 11.3）。Pearson相关性为r = 0.84（p < 0.001）。为检验LUS诊断ILD的准确性，选择了完全双侧的间质模式是/否标准，AUC具有显著性，为0.94（0.07）（95%CI 0.81 - 1.0，p = 0.014）。在患有ILD的Sjs患者中，LUS与hrCT具有极好的相关性，并且在日常临床实践中可能是评估干燥综合征肺部疾病的有用技术。
