Department of Rheumatology.
Department of Pulmonary Medicine.
Rheumatology (Oxford). 2021 Dec 1;60(12):5659-5667. doi: 10.1093/rheumatology/keab163.
This study aimed to describe pulmonary high-resolution CT (HRCT) findings in Takayasu arteritis (TA) and to determine possible causes.
A total of 243 TA patients were enrolled from a prospective cohort after excluding patients with other pulmonary disorders or incomplete data. Patients were divided into two groups: those with normal lung HRCT and those with abnormal lung HRCT. Clinical characteristics were compared between groups and binary logistic regression analysis was applied to identify possible causes of the lung lesions. Follow-up HRCT (obtained in 64 patients) was analysed to study changes in pulmonary lesions after treatment.
Of the 243 patients, 107 (44.0%) had normal lung HRCT while 136 (56.0%) had abnormal lung HRCT, including stripe opacity (60.3%), nodules (44.9%), patchy opacity (25.0%), pleural thickening (15.4%), pleural effusion (10.3%), ground-glass opacity (8.1%), pulmonary infarction (6.6%), mosaic attenuation (4.4%), bronchiectasis (3.7%) and pulmonary oedema (2.2%). Patients with abnormal HRCT were significantly more likely to have type II arterial involvement (25% vs 12.2%, P = 0.04), pulmonary arterial involvement (PAI; 21.3% vs 5.6%, P < 0.001), pulmonary hypertension (20.6% vs 8.4%, P = 0.01) and abnormal heart function (27.9% vs 7.6%, P < 0.001). Logistic regression analysis demonstrated that PAI, worsened heart function and age were associated with presence of pulmonary lesions. Pulmonary infarction, pleural effusion and patchy opacities improved partially after treatment.
Pulmonary lesions are not rare in patients with TA. Age, PAI and worsened heart function are potential risk factors for presence of pulmonary lesions in TA.
本研究旨在描述大动脉炎(TA)患者的肺部高分辨率 CT(HRCT)表现,并探讨可能的病因。
本研究纳入了 243 例大动脉炎患者,均来自一个前瞻性队列研究,排除了有其他肺部疾病或资料不全的患者。将患者分为两组:肺部 HRCT 正常组和肺部 HRCT 异常组。比较两组患者的临床特征,并应用二元逻辑回归分析来识别肺部病变的可能病因。对 64 例患者进行了随访 HRCT 检查,分析治疗后肺部病变的变化。
243 例患者中,107 例(44.0%)肺部 HRCT 正常,136 例(56.0%)肺部 HRCT 异常,异常表现包括:条带状影(60.3%)、结节(44.9%)、斑片状影(25.0%)、胸膜增厚(15.4%)、胸腔积液(10.3%)、磨玻璃影(8.1%)、肺梗死(6.6%)、马赛克征(4.4%)、支气管扩张(3.7%)和肺水肿(2.2%)。肺部 HRCT 异常的患者更易出现 II 型大血管病变(25% vs. 12.2%,P=0.04)、肺动脉受累(21.3% vs. 5.6%,P<0.001)、肺动脉高压(20.6% vs. 8.4%,P=0.01)和心功能异常(27.9% vs. 7.6%,P<0.001)。Logistic 回归分析显示,肺动脉受累、心功能恶化和年龄与肺部病变有关。经治疗后,部分患者的肺梗死、胸腔积液和斑片状影有所改善。
大动脉炎患者肺部病变并不少见。年龄、肺动脉受累和心功能恶化是大动脉炎患者肺部病变的潜在危险因素。