纵隔淋巴结肿大对慢性间质性肺疾病的预后价值。
Prognostic value of mediastinal lymph node enlargement in chronic interstitial lung disease.
机构信息
Department of Radiology, University of Parma, Parma, Italy.
Division of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy.
出版信息
Diagn Interv Radiol. 2021 May;27(3):329-335. doi: 10.5152/dir.2021.19585.
PURPOSE
Mediastinal lymph node (MLN) enlargement detected on chest computed tomography (CT) is frequent in patients with interstitial lung disease (ILD) and is shown in approximately 70% of cases of idiopathic pulmonary fibrosis (IPF). We hypothesized that enlarged MLNs might be a predictor of poor prognosis, associated with lower survival and stronger disease severity.
METHODS
This study included patients with idiopathic pulmonary fibrosis (IPF) or nonspecific interstitial pneumonia (NSIP) from January 2009 to December 2018. Baseline chest CT scan and one-year follow-up scan of the patients were reviewed for the extent of lung fibrosis and MLNs. Two radiologists independently assessed MLN diameter and location. Patients with drug toxicity-related ILD, sarcoidosis, chronic hypersensitivity pneumonitis and other rare idiopathic interstitial pneumonias were excluded. The primary endpoint was survival. Secondary endpoints included number of hospitalizations for respiratory causes, lung function evaluated by forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), and lung fibrosis score determined by CT scan.
RESULTS
We retrospectively reviewed the medical registries of 110 patients with chronic pulmonary fibrosis (mean age 71 years, 60.4% male). Nine participants were excluded because the CT scans were of poor diagnostic quality for the evaluation of the mediastinum or unavailable for review. The analysis of 101 patients showed that enlarged MLNs (short axis diameter ≥10 mm) were present in 50.5% (n=51) and strongly predicted survival (HR= 2.11, 95% CI 1.12-3.96, p = 0.020). Patients with MLN enlargement experienced greater number of hospitalizations for respiratory causes (mean 2.5 vs. 1.8, p = 0.010) and had significantly worse lung function parameters (FVC, 71% vs. 81%, p = 0.018 and DLCO, 40% vs. 50%, p = 0.001) and a higher lung fibrosis score (50% vs. 39%, p = 0.001).
CONCLUSION
In patients with IPF and NSIP, enlarged MLNs predict survival, are associated with increased number of hospitalizations, and show signs of poorer lung function and more severe fibrosis.
目的
胸部计算机断层扫描（CT）检测到的纵隔淋巴结（MLN）肿大在间质性肺疾病（ILD）患者中很常见，约 70%的特发性肺纤维化（IPF）病例存在这种情况。我们假设，增大的 MLN 可能是预后不良的预测因素，与生存率降低和疾病严重程度增强相关。
方法
本研究纳入了 2009 年 1 月至 2018 年 12 月间的特发性肺纤维化（IPF）或非特异性间质性肺炎（NSIP）患者。对患者的基线胸部 CT 扫描和一年随访扫描进行评估，以确定肺纤维化和 MLN 的范围。两名放射科医生独立评估 MLN 直径和位置。排除药物毒性相关 ILD、结节病、慢性过敏性肺炎和其他罕见的特发性间质性肺炎患者。主要终点是生存率。次要终点包括因呼吸原因住院的次数、用力肺活量（FVC）和一氧化碳弥散量（DLCO）评估的肺功能，以及 CT 扫描确定的肺纤维化评分。
结果
我们回顾性分析了 110 例慢性肺纤维化患者的医疗记录（平均年龄 71 岁，60.4%为男性）。9 名参与者因纵隔评估的 CT 扫描质量差或无法进行评估而被排除。对 101 例患者的分析显示，50.5%（n=51）存在增大的 MLN（短轴直径≥10mm），强烈预测生存率（HR=2.11，95%CI 1.12-3.96，p=0.020）。MLN 增大的患者因呼吸原因住院的次数更多（平均 2.5 次 vs. 1.8 次，p=0.010），肺功能参数明显更差（FVC，71% vs. 81%，p=0.018 和 DLCO，40% vs. 50%，p=0.001），肺纤维化评分更高（50% vs. 39%，p=0.001）。
结论
在 IPF 和 NSIP 患者中，增大的 MLN 预测生存率，与住院次数增加相关，并显示出肺功能更差和纤维化更严重的迹象。
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