Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Italy.
Unità Operativa di Pneumologia, Azienda Ospedaliero Universitaria "Ospedali Riuniti" - Ancona, Ancona, Italy.
Rheumatology (Oxford). 2020 Mar 1;59(3):641-649. doi: 10.1093/rheumatology/kez340.
The prevalence and clinical implications of small airways involvement in SSc are still to be fully elucidated. The goal of the present work is to assess the prevalence of small airways dysfunction by impulse oscillometry and to determine whether it correlates with selected disease-related features and respiratory-related quality of life.
Ninety-four SSc patients and 93 healthy controls were studied by impulse oscillometry measurements. Small airways dysfunction was defined as the difference between resistance at low frequency, i.e. 5 Hz, and resistance at high frequency, i.e. 20 Hz, termed 'R5-R20', ⩾0.07 kPa/l/s. The St George's Respiratory Questionnaire was used to measure health impairment in SSc patients. Radiological features of small airways disease and parenchymal abnormalities on high resolution CT chest scans were jointly assessed by two thoracic radiologists.
Small airways dysfunction was present in 21.5% of the SSc patient cohort, with a prevalence almost 5-fold higher compared with controls, and it was significantly associated with worse respiratory-related quality of life. Radiological features consistent with small airways abnormalities were detected in 25% of SSc patients, mostly in the absence of interstitial lung changes. Combining functional and radiological evaluations, one-third of the SSc cohort showed at least one feature of small airways involvement, which was associated with the lcSSc phenotype and with longer disease duration.
The current study strengthens the hypothesis that small airway dysfunction might be a feature of SSc-related lung involvement, providing the first data on its significant impact on respiratory-related quality of life. A full assessment of lung function in SSc patients should include impulse oscillometry as a complementary technique, due to potential clinical and therapeutic implications.
SSc 中小气道受累的患病率及其临床意义仍有待充分阐明。本研究旨在通过脉冲震荡法评估小气道功能障碍的患病率，并确定其是否与某些疾病相关特征和与呼吸相关的生活质量相关。
研究共纳入 94 例 SSc 患者和 93 例健康对照者，采用脉冲震荡法进行检测。小气道功能障碍定义为低频（5Hz）与高频（20Hz）阻力差值（即 R5-R20）≥0.07kPa·l/s。采用圣乔治呼吸问卷评估 SSc 患者的健康受损情况。两位胸部放射科医生联合评估胸部高分辨率 CT 扫描的小气道疾病和实质异常的放射学特征。
SSc 患者队列中有 21.5%存在小气道功能障碍，其患病率几乎是对照组的 5 倍，且与更差的与呼吸相关的生活质量显著相关。在 25%的 SSc 患者中检测到与小气道异常一致的放射学特征，主要在无间质性肺改变的情况下。结合功能和放射学评估，三分之一的 SSc 患者至少存在一种小气道受累的特征，与局限型 SSc 表型和更长的病程相关。
本研究进一步证实了小气道功能障碍可能是 SSc 相关肺受累的特征之一，提示其对与呼吸相关的生活质量有显著影响。在 SSc 患者中，肺功能评估应包括脉冲震荡法作为一种补充技术，因为其具有潜在的临床和治疗意义。
