Sant S M, Doran M, Fenelon H M, Breatnach E S
Department of Rheumatology, Mater Misericordiae Hospital, Dublin, Ireland.
Clin Exp Rheumatol. 1997 Sep-Oct;15(5):507-13.
To assess the nature of pleuropulmonary abnormalities, with particular reference to interstitial lung disease (ILD), in patients with systemic lupus erythematosus (SLE).
29 patients were prospectively evaluated using high resolution computed tomography (HRCT), plain chest radiography (CXR) and pulmonary function tests (PFTs). Clinical assessments, drug therapy, disease activity, smoking status and serologic markers were also noted.
The HRCT was abnormal in 72% (20/29) of patients, while 34% (10/29) had an abnormal CXR. The most frequently detected primary HRCT abnormality was suggestive of ILD and was noted in 11 patients (38%) In 9 of these, ILD was clinically unsuspected, including one patient who had an HRCT suggestive of active alveolitis. Pleuropericardial abnormalities were seen on HRCT in 5 patients (17%). Of 15 patients who were asymptomatic, and had a normal examination, normal CXR and normal PFTs, four (26%) had HRCT features of ILD. There was no correlation between the HRCT appearances and symptoms, disease duration, ds-DNA titres, smoking history or non-pulmonary involvement. Although no statistical significance was noted between abnormal pulmonary function tests and ILD on HRCT (0.10 < p < 0.20), a trend towards significance was noted between disease activity and ILD (0.05 < p < 0.01).
HRCT is more sensitive than PFTs or CXR in the evaluation of pleuropulmonary disease in SLE. We report an unusually high prevalence of HRCT appearances suggestive of ILD in patients with SLE. Subclinical lung disease is common in patients with SLE.
评估系统性红斑狼疮（SLE）患者胸膜肺部异常的性质，尤其关注间质性肺疾病（ILD）。
对29例患者进行前瞻性评估，采用高分辨率计算机断层扫描（HRCT）、胸部X线平片（CXR）和肺功能测试（PFTs）。还记录了临床评估、药物治疗、疾病活动度、吸烟状况和血清学标志物。
72%（20/29）的患者HRCT异常，而34%（10/29）的患者CXR异常。最常检测到的原发性HRCT异常提示ILD，11例患者（38%）出现该异常。其中9例患者临床上未怀疑有ILD，包括1例HRCT提示有活动性肺泡炎的患者。5例患者（17%）的HRCT显示有胸膜心包异常。15例无症状、检查正常、CXR和PFTs均正常的患者中，4例（26%）有ILD的HRCT特征。HRCT表现与症状、疾病持续时间、双链DNA滴度、吸烟史或肺外受累情况之间无相关性。虽然肺功能测试异常与HRCT上的ILD之间未发现统计学意义（0.10 < p < 0.20），但疾病活动度与ILD之间有显著趋势（0.05 < p < 0.01）。
在评估SLE患者的胸膜肺部疾病时，HRCT比PFTs或CXR更敏感。我们报告SLE患者中HRCT表现提示ILD的患病率异常高。亚临床肺部疾病在SLE患者中很常见。
