發(fā)布時間：2018-08-06 16:56

【摘要】：目的：利用薄層CT掃描骨重建觀察系統(tǒng)性紅斑狼瘡患者胸部病變的表現(xiàn)，探討胸部CT表現(xiàn)與系統(tǒng)性紅斑狼瘡患者的年齡、病程及其血清檢測指標（C3、CRP、抗dsDNA抗體、抗Sm抗體）異常時的相關性。通過上述研究試圖探討系統(tǒng)性紅斑狼瘡胸部病變的可能發(fā)生機制。 方法：選取2012年3月-2013年3月在大連醫(yī)科大學附屬第一醫(yī)院住院的系統(tǒng)性紅斑狼瘡39例連續(xù)性病例。所有受試者均行血清實驗室CRP、C3、抗ds-DNA抗體、抗Sm抗體檢測與胸部CT掃描檢查。結合分析全部病例的胸部CT表現(xiàn)，肺間質、肺實質、氣道及胸膜的改變，探討系統(tǒng)性紅斑狼瘡患者的胸部CT異常改變與其年齡、病程及CRP、C3、抗ds-DNA抗體、抗Sm抗體檢測指標變化的相關性。所有實驗室檢查都采用目前的標準檢測方法。 結果：1、胸部CT影像表現(xiàn)：全部39例患者中，36例（92.3%）有改變，間質性改變最常見，其中19例（48.7%）出現(xiàn)胸膜改變，多為胸膜增厚（68.4%）；14例（35.9%）有氣道改變，多表現(xiàn)為支氣管擴張（64.3%）。36例有間質性改變的患者中，以小葉間隔增厚與胸膜下線增厚常見，發(fā)生率分別為46.2%及20.5%，多分布在兩肺的下野外帶；磨玻璃影與含氣腔隙實變次之，發(fā)生率28.2%，兩肺均勻分布。 2、臨床資料與CT表現(xiàn)的相關性：39例病例中男性4例，女性35例；年齡18-79歲，平均年齡為49.3616.56歲。病程從初發(fā)到二十年，，平均病程4.946.36年。39例患者中C3補體陽性20例，占51.3%，CRP陽性20例，占51.3%,抗ds-DNA抗體陽性23例，占59%,抗Sm抗體陽性19例，占48.7%。氣道有無受累的兩組出現(xiàn)抗ds-DNA抗體陽性的差異有統(tǒng)計學意義；抗ds-DNA、C3補體與年齡、病程是反應氣道受侵的指標之一；年長且病程較長、C3補體陽性、ds-DNA陰性者更易發(fā)生氣道改變。 結論： 1、SLE患者胸部改變的影像表現(xiàn)缺乏特異性，然CT薄層骨重建能直觀地觀察系統(tǒng)性紅斑狼瘡的胸部病變，主要表現(xiàn)在：○1、間質性改變最常見：早期改變?yōu)槟ゲＡв埃ǘ酁榫鶆蚍植迹�，且會出現(xiàn)在病程的任何階段，晚期主要為蜂窩狀纖維化改變（多在下肺野、外肺帶）；○2、胸膜炎/胸腔積液：胸膜炎為胸膜增厚，胸腔積液多為雙側少量或中等量積液；○3、氣道改變：多表現(xiàn)為支氣管擴張。 2、病程長短對SLE的氣道改變有統(tǒng)計學意義,而抗ds-DNA、C3及年齡、病程是反應氣道受侵的指標，年齡大且病程較長者、C3陽性與ds-DNA陰性者更易發(fā)生氣道改變。 3、血清學ANA、抗Sm抗體、CRP的變化與胸部病變沒有相關性，說明胸部病變并非如腎臟病變一樣為單純免疫復合物浸潤的結果，可能是與炎性參與或者其他更為復雜因素相互作用的結果。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R593.241;R816.4

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