Wangkaew Suparaporn, Losuriya Phumiphat, Euathrongchit Juntima
Divisions of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Clin Rheumatol. 2021 Mar;40(3):955-963. doi: 10.1007/s10067-020-05346-3. Epub 2020 Aug 15.
Data regarding longitudinal association between changes (Δ: time2-time1) in the widest esophageal diameter (WED) and Δ HRCT score in early SSc-ILD patients is limited. We therefore investigated the association of ΔWED with Δ HRCT score and predictors of a worse Δ HRCT score in those patients.
We used an inception cohort of early SSc-ILD patients with availability for two HRCT records at enrollment and 1-year follow-up.The extent of ground glass, reticulation, bronchiectasis, and honeycombing was scored and then aggregated to produce a total HRCT score. The WED was measured at four levels and the maximum value was used. The Δ maximum WED, Δ mean WED, and Δ tHRCT score were analyzed.
We recruited 75 early SSc-ILD patients and found a significant correlation of Δ tHRCT score with a Δ maximum WED (rho = 0.34, p < 0.01) and Δ mean WED (rho = 0.26, p < 0.05). There were 34 patients with a worsening Δ tHRCT (Δ > 0), 17 with stability (Δ = 0), and 24 with improvement (Δ < 0). Patients with a worsening ILD had a significantly shorter disease duration, lower prevalence of tendon friction rub, higher cumulative prednisolone dose, and larger ΔWED than those with stable and improved Δ tHRCT scores. Multivariate ordinal logistic regression identified a larger Δ mean WED (OR 1.21, 95% CI 1.03-1.42, p = 0.02) as a predictor of worsening HRCT score, while presence of tendon friction rub was associated with a lower risk (OR 0.18, 95% CI 0.04-0.77, p = 0.021).
Our study cohort found that a worsening esophageal diameter was a predictor of progression of lung fibrosis determined by HRCT score in early SSc-ILD. A further study regarding esophageal dilation progression different in early versus longstanding SSc-ILD is needed. Key Points •In early SSc-ILD patients, we demonstrated that a worsening esophageal diameter was a predictor of progression of HRCT score at 1-year follow-up. •Further study regarding the association of worsening of the esophageal dilatation with the progression of ILD comparing between early versus late SSc-ILD is needed.
早期系统性硬化症相关间质性肺病（SSc-ILD）患者中，关于食管最宽直径（WED）变化（Δ：时间2 - 时间1）与Δ HRCT评分之间纵向关联的数据有限。因此，我们研究了ΔWED与Δ HRCT评分之间的关联，以及这些患者中Δ HRCT评分较差的预测因素。
我们使用了一个早期SSc-ILD患者的起始队列，这些患者在入组时和1年随访时有两次HRCT记录。对磨玻璃影、网状影、支气管扩张和蜂窝肺的范围进行评分，然后汇总得出总HRCT评分。在四个层面测量WED，并使用最大值。分析了Δ最大WED、Δ平均WED和Δ tHRCT评分。
我们招募了75例早期SSc-ILD患者，发现Δ tHRCT评分与Δ最大WED（rho = 0.34，p < 0.01）和Δ平均WED（rho = 0.26，p < 0.05）之间存在显著相关性。有34例患者的Δ tHRCT恶化（Δ>0），17例稳定（Δ = 0），24例改善（Δ<0）。与Δ tHRCT评分稳定和改善的患者相比，ILD恶化的患者病程明显更短，肌腱摩擦音的患病率更低，泼尼松龙累积剂量更高，且ΔWED更大。多变量有序逻辑回归确定，较大的Δ平均WED（OR 1.21，95% CI 1.03 - 1.42，p = 0.02）是HRCT评分恶化的预测因素，而存在肌腱摩擦音与较低风险相关（OR 0.18，95% CI 0.04 - 0.77，p = 0.021）。
我们的研究队列发现，食管直径恶化是早期SSc-ILD患者中由HRCT评分确定的肺纤维化进展的预测因素。需要进一步研究早期与长期SSc-ILD中食管扩张进展的差异。要点•在早期SSc-ILD患者中，我们证明食管直径恶化是1年随访时HRCT评分进展的预测因素。•需要进一步研究比较早期与晚期SSc-ILD中食管扩张恶化与ILD进展之间的关联。
