Zhu Wei-Wei, Li Yi-Dan, Li Hong, Lu Xiu-Zhang, Kong Ling-Yun, Ye Xiao-Guang, Cai Qi-Zhe, Sun Lan-Lan, Jiang Wei, Wang Li
Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
Ultrasound Med Biol. 2017 Apr;43(4):744-752. doi: 10.1016/j.ultrasmedbio.2016.11.004. Epub 2017 Jan 7.
The aims of this study were to apply integrative cardiopulmonary ultrasound (thoracic ultrasound) to the evaluation of patients with interstitial lung disease (ILD) and to determine the relationship between lung ultrasound signs and echocardiographic parameters such as systolic pulmonary artery pressure (SPAP) and various right ventricular parameters. ILD patients and healthy controls underwent lung ultrasound (LUS) and echocardiographic tests. In addition to traditional echocardiographic parameters, right ventricular free wall longitudinal strain (RVLS_FW) was measured using 2-D speckle-tracking echocardiography. The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored with a semiquantitative scoring method, taking into account multiple LUS signs. Statistical analyses were performed to compare various parameters between ILD patients with and those without pulmonary hypertension. Correlations between the different parameters were then evaluated, and the LUS scores were used to predict pulmonary hypertension using a receiver operating characteristic curve analysis. Among the 90 patients who qualified for entry into this study, 30% (n = 27) had pulmonary hypertension. The patients with pulmonary hypertension had larger right ventricular dimensions, lower RVLS_FW and higher LUS scores. An effective correlation was found between ILD LUS scores and echocardiographic parameters, especially SPAP (r = 0.735, p < 0.001). The groups were comparable with respect to most echocardiographic parameters, with mild, moderate and severe pulmonary fibrosis, whereas SPAP was significantly higher in the moderate and severe groups. RVLS_FW was obviously reduced in the group with severe pulmonary fibrosis. Although RVLS_FW in the mild pulmonary fibrosis group was in the normal range, it was slightly reduced compared with that of the controls. A cutoff of more than 16 LUS points had 85.2% sensitivity and 80.3% specificity in predicting elevated SPAP (>36 mm Hg). Thoracic ultrasound is useful in the assessment of ILD. As ILD progresses, the structure or function of the right ventricle gradually deteriorates. LUS not only detects lung conditions in ILD, but also indirectly reflects SPAP and right ventricular function. Integrated use of LUS and echocardiography will provide an invaluable point-of-care imaging modality to facilitate the diagnosis, management and treatment of patients with ILD.
本研究的目的是应用综合心肺超声（胸部超声）评估间质性肺疾病（ILD）患者，并确定肺部超声征象与诸如收缩期肺动脉压（SPAP）及各种右心室参数等超声心动图参数之间的关系。ILD患者和健康对照者接受了肺部超声（LUS）和超声心动图检查。除了传统的超声心动图参数外，还使用二维斑点追踪超声心动图测量右心室游离壁纵向应变（RVLS_FW）。采用半定量评分方法，综合多种LUS征象对每位ILD患者的肺纤维化程度或疾病严重程度进行评分。进行统计学分析以比较有和没有肺动脉高压的ILD患者之间的各种参数。然后评估不同参数之间的相关性，并使用受试者工作特征曲线分析，用LUS评分来预测肺动脉高压。在符合本研究纳入标准的90例患者中，30%（n = 27）患有肺动脉高压。患有肺动脉高压的患者右心室尺寸更大，RVLS_FW更低，LUS评分更高。发现ILD的LUS评分与超声心动图参数之间存在有效相关性，尤其是与SPAP（r = 0.735，p < 0.001）。在大多数超声心动图参数方面，轻度、中度和重度肺纤维化组之间具有可比性，而中度和重度组的SPAP显著更高。重度肺纤维化组的RVLS_FW明显降低。虽然轻度肺纤维化组的RVLS_FW在正常范围内，但与对照组相比略有降低。LUS评分大于16分时，预测SPAP升高（>36 mmHg）的敏感性为85.2%，特异性为80.3%。胸部超声对ILD的评估有用。随着ILD进展，右心室的结构或功能逐渐恶化。LUS不仅能检测ILD中的肺部情况，还能间接反映SPAP和右心室功能。LUS和超声心动图的联合应用将提供一种非常有价值的床旁成像模式，以促进ILD患者的诊断、管理和治疗。
