Study On Diagnosis And Clinical Application Of Lung Ultrasound In Interstitial Lung Diseases Associated With Connective Tissue Disease

Objective:Connective tissue disease(CTD)is a group of immune-mediated systemic diseases in which interstitial lung disease(ILD)is the dominant pulmonary manifestation.At present,high resolution computed tomography(HRCT)is still the gold standard for the diagnosis and differential diagnosis of ILD.However,due to the high ionizing radiation of HRCT,it is not suitable for the special population(such as pregnant women)to review at any time.Moreover,HRCT is mainly conducted in the radiology examination room of the hospital,and bedside examination cannot be carried out on severe patients or long-term bedridden patients.Besides,the examination cost is high,and short-term and multiple examinations cannot be carried out.Therefore,it is necessary to find a simple,quick and convenient lung imaging method for bedside examination.Lung ultrasound(LUS)is a promising tool for detection of ILD.Previous studies have shown that B-line,subpleural changes such as pleural fragmentation,pleural thickening and pleural irregularity observed by lung ultrasound have good diagnostic accuracy for the disease,especially its higher sensitivity compared with HRCT.It has been proved that pulmonary ultrasound is a new,non-radiative and simple imaging method,which has been widely used in the diagnosis of a variety of lung diseases.The purpose of this study was to evaluate pulmonary ultrasound as a screening method for pulmonary interstitial involvement in patients secondary to connective tissue disease,The clinical application value of connective tissue disease associated with interstitial lung disease associated with connective tissue disease(CTD-ILD)with ultrasonography was also discussed and the evaluation of connective tissue disease severity was evaluated.In order to find a simple,sensitive and specific ultrasonic detection method for CTD-ILD,and provide reference for its clinical application.Methods:A total of 100 patients in the outpatient department of rheumatology and immunology of our hospital from December 2021 to December 2022 were collected.After screening,19 patients were excluded,and 81 patients were eventually included.All patients underwent lung ultrasound examination within 1 week after HRCT.General demographic data(such as gender,age,etc.)and clinical manifestations of patients were collected,manifestations under HRCT(such as honeycomb,ground glass shadow,pulmonary interstitial fibrosis,etc.),and all 72 lung intercostal space(lung intercostal space,lung intercostal space,lung intercostal space,etc.)were collected.LIS)number of B-lines,subpleural changes(e.g.,pleural thickening,pleural fragmentation,pleural irregularity,etc.).All HRCT results were quantified by Warrick’s score scale.All lung ultrasound results were quantified by the LUS semi-quantitative Scoring Scale proposed by Buda et al in 2016.The general demographic data and clinical manifestations of all patients were analyzed.The imaging features of CTD-ILD patients under lung ultrasound and HRCT were analyzed and analyzed.Compared with HRCT,the differences of lung ultrasound performance between control group and CTD group,control group and ILD group,CTD group and CTD-ILD group,ILD group and CTD-ILD group were analyzed.To analyze the consistency and diagnostic value of lung ultrasound in CTD-ILD patients compared with HRCT.To evaluate the severity of ILD in CTD-ILD patients by lung ultrasound compared with HRCT.Compared with HRCT,the differences between the scanning methods of 72 LIS and the simplified scanning methods of 8 LIS were analyzed.t test,Chi-square test,rank sum test and ROC curve were used for statistical analysis of the data.Results:1.A total of 81 outpatient patients of our department from December 2021 to December 2022 were included in this study,of which 13 were control group(16.05%);Nineteen patients(23.46%)(8 cases of osteoarthritis(0.01%),3 cases of healthy patients(0.04%),and 1 case of other patients(0.01%))had interstitial lung disease secondary to other diseases(including 10 patients with chronic obstructive pulmonary disease(12.35%),2 patients with pneumoconiosis(0.02%),and 7 patients with other diseases(0.09%)).There were 20 patients(24.69%)with connective tissue disease without interstitial lung disease(including 12 patients with rheumatoid arthritis(14.81%),1patient with systemic sclerosis(0.01%),4 patients with ankylosing spondylitis(0.05%),and 3 patients with systemic lupus erythematosus(0.04%)).There were 29 patients(35.80%)with connective tissue disease combined with interstitial lung(including 17 patients with rheumatoid arthritis(20.99%),8 patients with systemic sclerosis(0.10%),and 4 patients with inflammatory myopathy(0.05%)).2.The results showed that there was no significant difference in semi-quantitative LUS score between the control group and the CTD group(P > 0.05).The semi-quantitative score of LUS under lung ultrasound was significantly different between control group and ILD group(P < 0.05).The semi-quantitative LUS score of lung ultrasound was significantly different between CTD group and CTD-ILD group(P <0.05).There was significant difference in semi-quantitative LUS score between ILD group and CD-ILD group(P < 0.05).3.The analysis showed that there was no statistical significance in semi-quantitative LUS scores between the negative control group and the CTD group(P > 0.05).The semi-quantitative score of LUS under lung ultrasound was significantly different between negative control group and ILD group(P < 0.05).The semi-quantitative LUS score of lung ultrasound was significantly different between CTD group and CTD-ILD group(P< 0.05).There was significant difference in semi-quantitative LUS score between ILD group and CTD-ILD group(P < 0.05).4.Compared with HRCT,the area under ROC curve of lung ultrasound for the diagnosis of CTD-ILD patients was 0.946,the calculated truncation value was 12.5,the sensitivity was 0.966,the specificity was 0.865,and the maximum entry index was0.831.5.Compared with HRCT,the Z-value and P value of lung ultrasound in the evaluation of severity of CTD-ILD were-0.597 and 0.551 > 0.05,respectively,and the difference was not statistically significant.6.Compared with 72 LIS scans in the whole lung,there was no significant difference between the LUS semi-quantitative scores of 8 LIS scans and 72 LIS scans(P=0.701 > 0.05).Conclusion:1.Lung ultrasound manifestations in patients with CTD-ILD,such as B-line and subpleural changes,were mainly distributed in the posterior axillary line,the intercostal space at the intersection of the shoulder line and the 7th and 8th thoracic vertebrae,and some severe patients were also distributed in the middle axillary line of the right lung,the anterior axillary line and the intercostal space at the intersection of the 5th rib.2.LUS can detect pulmonary interstitial involvement in patients with systemic connective tissue disease with high sensitivity and specificity.3.It is feasible to evaluate the severity of CTD-ILD patients with lung ultrasound by semi-quantitative scoring of LUS.4.Compared with 72 LIS scanning methods in the whole lung,8 LIS ultrasound scans were shorter and less time-consuming.