ISSN 1004-4140
CN 11-3017/P

基于定量CT评估CTD-ILD肺纤维化严重程度的研究

Quantitative CT Assessment of Pulmonary Fibrosis Severity in Patients with Connective Tissue Disease-associated Interstitial Lung Disease

  • 摘要: 目的:结合视觉评分及定量CT指标对患者肺纤维化严重程度进行风险分层。方法:纳入96例结缔组织疾病相关间质性肺病(CTD-ILD)患者和47例无间质性肺疾病(ILD)的结缔组织病(CTD)对照组,采用Warrick评分和3D Slicer密度直方图法评估肺纤维化程度。结果:标准差(SD)、峰度(Kurtosis)、偏度(Skewness)在不同严重程度组间存在显著差异。多因素逻辑回归显示,高衰减区(HAA%)是患者肺纤维化程度的独立预测指标。受试者操作特征曲线(ROC)表明,联合所有定量CT参数区分正常轻度与中重度患者曲线下面积(AUC)为0.846(灵敏度0.739,特异度0.885)。相关性分析显示,Perc10、Perc15、MLA与RV/TLC存在较弱的正相关。结论:该方法可无创、客观评估CTD-ILD严重程度,为肺功能检测受限患者提供有效替代方案,降低诊疗成本,适合基层推广。

     

    Abstract: Objective: To classify pulmonary fibrosis severity in connective tissue disease-associated interstitial lung disease (CTD-ILD) patients by integrating visual scoring and quantitative computed tomography (CT). Methods: A total of 96 patients with CTD-ILD and 47 CTD controls without ILD were enrolled. Pulmonary fibrosis was evaluated using the Warrick score and the 3D slicer-based density histogram method. Results: Significant differences were observed in standard deviation (SD), kurtosis, and skewness across the severity groups. Multivariate logistic regression analysis identified HAA as an independent predictor of fibrosis severity. The receiver-operating characterisric curve (ROC) showed that combining all quantitative CT parameters achieved an area under the curve (AUC) of 0.846 (sensitivity=0.739 and specificity=0.885) to distinguish normal/mild cases from moderate/severe cases. Weak positive correlations were observed between Perc10, Perc15, MLA, and RV/TLC. Conclusion: This approach enables a noninvasive and objective assessment of CTD-ILD severity, thereby providing a clinically valuable alternative for patients with limitations in pulmonary function testing, reducing diagnostic and therapeutic costs, and demonstrating a strong potential for widespread implementation in primary healthcare settings.

     

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