肺部密度和肺动脉直径是系统性硬化症中肺动脉高压的预测指标。

Lung Density and Pulmonary Artery Diameter are Predictors of Pulmonary Hypertension in Systemic Sclerosis.

机构信息

Departments of *Radiology, Division of Image Processing †Pulmonology ‡Radiology §Rheumatology ¶Cardiology, Leiden University Medical Center, Leiden ∥Haga Teaching Hospital, The Hague, The Netherlands.

出版信息

J Thorac Imaging. 2017 Nov;32(6):391-397. doi: 10.1097/RTI.0000000000000279.

DOI:10.1097/RTI.0000000000000279

PMID:28549020

Abstract

PURPOSE

The aim was to evaluate computed tomography (CT)-measured pulmonary artery diameter (PAD) and lung density as predictors of pulmonary hypertension (PH) in subjects with systemic sclerosis (SSc). We compared these PAD values with normal values and between SSc subgroups with PH and/or interstitial lung disease (ILD). We investigated whether PAD predicts PH and whether lung densitometry, by using the 85th percentile density value (Perc85) as a measure for ILD, can predict PH.

MATERIALS AND METHODS

PAD and Perc85 were measured in axial CT scans and compared between 54 SSc and 76 control subjects. Four SSc subgroups were defined on the basis of PH (systolic PA pressure ≥35 mm Hg) and/or ILD (fibrosis score ≥7): PH-/ILD-, PH-/ILD+, PH+/ILD-, and PH+/ILD+. The association of PAD with age, body mass index, Perc85, lung function, and hemodynamic measures was investigated using univariate correlation along with the predictive value of these measures with respect to PH.

RESULTS

PAD in SSc was larger than that in controls (30.1±4.9 vs. 26.9±2.7 mm, P<0.001). PH+ patients showed increased PAD compared with PH- patients (34.2±4.2 vs. 28.6±4.3 mm, P<0.001), where PH+/ILD+ subjects showed the widest diameter (34.6±4.1 mm). In SSc patients, hemodynamic measures, age, body mass index, Perc85, and lung function correlated with PAD. PAD was best explained by Perc85, together with age (R=0.358). PAD best predicted PH (AUC, 0.877; P<0.001), and PAD≥30.7 mm showed 80% sensitivity and 87% specificity. Perc85 also predicted PH (AUC, 0.733; P=0.024).

CONCLUSIONS

In subjects with SSc, lung density and PAD are CT markers, each with predictive value for PH.

摘要

目的

评估系统性硬化症（SSc）患者的计算机断层扫描（CT）测量的肺动脉直径（PAD）和肺密度作为肺动脉高压（PH）的预测指标。我们将这些 PAD 值与正常值进行比较，并比较 PH 和/或间质性肺病（ILD）的 SSc 亚组之间的 PAD 值。我们研究了 PAD 是否可以预测 PH，以及使用 85 百分位密度值（Perc85）作为ILD 指标的肺密度测量是否可以预测 PH。

材料和方法

在轴向 CT 扫描中测量 PAD 和 Perc85，并在 54 例 SSc 和 76 例对照受试者之间进行比较。根据 PH（收缩期 PA 压≥35mmHg）和/或 ILD（纤维化评分≥7）定义了四个 SSc 亚组：PH-/ILD-、PH-/ILD+、PH+/ILD-和 PH+/ILD+。使用单变量相关性研究了 PAD 与年龄、体重指数、Perc85、肺功能和血流动力学指标的相关性，并研究了这些指标对 PH 的预测价值。

结果

SSc 患者的 PAD 大于对照组（30.1±4.9 与 26.9±2.7mm，P<0.001）。与 PH-患者相比，PH+患者的 PAD 增加（34.2±4.2 与 28.6±4.3mm，P<0.001），其中 PH+/ILD+患者的直径最宽（34.6±4.1mm）。在 SSc 患者中，血流动力学指标、年龄、体重指数、Perc85 和肺功能与 PAD 相关。PAD 与 Perc85 和年龄一起可以最好地解释（R=0.358）。PAD 可以最好地预测 PH（AUC，0.877；P<0.001），并且 PAD≥30.7mm 具有 80%的敏感性和 87%的特异性。Perc85 也可以预测 PH（AUC，0.733；P=0.024）。