系统性红斑狼疮胸部CT表现与CRP、C3、抗ds-DNA抗体、抗Sm抗体的相关性研究

发布时间：2018-08-06 16:56

【摘要】：目的：利用薄层CT扫描骨重建观察系统性红斑狼疮患者胸部病变的表现，探讨胸部CT表现与系统性红斑狼疮患者的年龄、病程及其血清检测指标（C3、CRP、抗dsDNA抗体、抗Sm抗体）异常时的相关性。通过上述研究试图探讨系统性红斑狼疮胸部病变的可能发生机制。方法：选取2012年3月-2013年3月在大连医科大学附属第一医院住院的系统性红斑狼疮39例连续性病例。所有受试者均行血清实验室CRP、C3、抗ds-DNA抗体、抗Sm抗体检测与胸部CT扫描检查。结合分析全部病例的胸部CT表现，肺间质、肺实质、气道及胸膜的改变，探讨系统性红斑狼疮患者的胸部CT异常改变与其年龄、病程及CRP、C3、抗ds-DNA抗体、抗Sm抗体检测指标变化的相关性。所有实验室检查都采用目前的标准检测方法。结果：1、胸部CT影像表现：全部39例患者中，36例（92.3%）有改变，间质性改变最常见，其中19例（48.7%）出现胸膜改变，多为胸膜增厚（68.4%）；14例（35.9%）有气道改变，多表现为支气管扩张（64.3%）。36例有间质性改变的患者中，以小叶间隔增厚与胸膜下线增厚常见，发生率分别为46.2%及20.5%，多分布在两肺的下野外带；磨玻璃影与含气腔隙实变次之，发生率28.2%，两肺均匀分布。 2、临床资料与CT表现的相关性：39例病例中男性4例，女性35例；年龄18-79岁，平均年龄为49.3616.56岁。病程从初发到二十年，，平均病程4.946.36年。39例患者中C3补体阳性20例，占51.3%，CRP阳性20例，占51.3%,抗ds-DNA抗体阳性23例，占59%,抗Sm抗体阳性19例，占48.7%。气道有无受累的两组出现抗ds-DNA抗体阳性的差异有统计学意义；抗ds-DNA、C3补体与年龄、病程是反应气道受侵的指标之一；年长且病程较长、C3补体阳性、ds-DNA阴性者更易发生气道改变。结论： 1、SLE患者胸部改变的影像表现缺乏特异性，然CT薄层骨重建能直观地观察系统性红斑狼疮的胸部病变，主要表现在：○1、间质性改变最常见：早期改变为磨玻璃影（多为均匀分布），且会出现在病程的任何阶段，晚期主要为蜂窝状纤维化改变（多在下肺野、外肺带）；○2、胸膜炎/胸腔积液：胸膜炎为胸膜增厚，胸腔积液多为双侧少量或中等量积液；○3、气道改变：多表现为支气管扩张。 2、病程长短对SLE的气道改变有统计学意义,而抗ds-DNA、C3及年龄、病程是反应气道受侵的指标，年龄大且病程较长者、C3阳性与ds-DNA阴性者更易发生气道改变。 3、血清学ANA、抗Sm抗体、CRP的变化与胸部病变没有相关性，说明胸部病变并非如肾脏病变一样为单纯免疫复合物浸润的结果，可能是与炎性参与或者其他更为复杂因素相互作用的结果。
[Abstract]:Objective: to observe the appearance of chest lesions in patients with systemic lupus erythematosus (SLE) by thin slice CT scanning bone reconstruction, and to investigate the age, course of disease and serum detection index (C3-CRP, anti dsDNA antibody) of patients with systemic lupus erythematosus (SLE). The correlation of anti-Sm antibody when abnormal. This study attempts to explore the possible mechanism of chest lesions in systemic lupus erythematosus. Methods: 39 consecutive cases of systemic lupus erythematosus were selected from March 2012 to March 2013 in the first affiliated Hospital of Dalian Medical University. All subjects were examined with serum CRP3, anti ds-DNA antibody, anti Sm antibody and chest CT scan. Combined with the analysis of chest CT findings, pulmonary interstitial, pulmonary parenchyma, airway and pleural changes in all patients, the abnormal changes of chest CT in patients with systemic lupus erythematosus (SLE) and their age, course of disease, CRP- C3, anti ds-DNA antibody were studied. Correlation of changes of anti-Sm antibody. All laboratory tests are conducted using current standard testing methods. Results among the 39 cases, 36 cases (92.3%) had the changes of interstitial changes, 19 cases (48.7%) had pleural changes, and 14 cases (35.9%) had airway changes, most of which were pleural thickening (68.4%). Most of them were bronchiectasis (64.3%) .36 patients with interstitial changes, the interlobular septal thickening and the subpleural thickening were common, the incidence rates were 46.2% and 20.5% respectively. The incidence rate was 28.2and the two lungs were evenly distributed. 2. The correlation between clinical data and CT findings was observed in 39 cases, including 4 males and 35 females, aged 18-79 years, with an average age of 49.3616.56 years. The mean course of disease was 4.946.36 years (20 / 39), accounting for 51.3% (20 / 39) of positive C 3 complement, 23 cases (59%) of anti ds-DNA antibody and 19 cases of anti Sm antibody (48.7%). There was significant difference between the two groups with or without airway involvement in anti-ds-DNA C3 complement and age, the course of disease was one of the indicators of airway invasion, and the older and longer C3-complement positive ds-DNA negative patients were more likely to develop airway changes. Conclusion: 1 the imaging features of chest changes in SLE patients lack specificity, but CT thin bone reconstruction can directly observe the chest lesions of systemic lupus erythematosus. The most common changes were as follows: the early changes were glass-grinding (mostly uniform distribution) and appeared at any stage of the course of disease, and the late stage was mainly honeycomb fibrosis (mostly in the lower lung field and the outer lung zone). 02.pleurisy / pleural effusion: pleural thickening, pleural effusion mostly bilateral small or moderate effusion, airway change: bronchiectasis. 2. The course of disease has statistical significance to the change of SLE airway. However, the duration of anti-ds-DNA C _ 3 and age was an indicator of airway invasion. Older and older patients with positive C _ 3 and ds-DNA negative were more likely to develop airway changes. There was no correlation between the changes of serum Ana and anti-Sm antibody and chest lesions. These results suggest that chest lesions are not the result of simple immune complex infiltration as renal lesions, but may be the result of interaction with inflammatory involvement or other more complex factors.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R593.241;R816.4

【参考文献】