Đặc điểm lâm sàng và cận lâm sàng bệnh phổi mô kẽ trong bệnh lý mô liên kết=Clinical and subclinical characteristics of interstitial lung disease in connective tissue disease

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Tác giả: Văn Dân Bùi, Đình Tùng Lê, Anh Minh Nguyễn, Hoàng Phương Nguyễn, Minh Long Triều Trần, Văn Lượng Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Nghiên cứu y học (Đại học Y Hà Nội), 2024

Mô tả vật lý: tr.27-35

Bộ sưu tập: Metadata

ID: 244730

Thêm vào giỏ

Nghiên cứu của chúng tôi được thực hiện với mục đích đánh giá tần suất và kiểu hình của bệnh phổi mô kẽ (interstitial lung disease - ILD) ở người bệnh đã được chẩn đoán bệnh mô liên kết (connective tissue disease - CTD). Nghiên cứu mô tả cắt ngang trên 49 người bệnh đã được chẩn đoán xác định CTD bao gồm xơ cứng bì hệ thống (systemic sclerosis - SSc), lupus ban đỏ hệ thống (systemic lupus erythematosus - SLE), viêm đa cơ/viêm da cơ (polymyositis/dermatomyositis - PM/DM) và bệnh mô liên kết hỗn hợp (mixed connective tissue disease - MCTD), điều trị tại Trung tâm Dị ứng - Miễn dịch lâm sàng, Bệnh viện Bạch Mai từ tháng 8/2023 đến tháng 2/2024. Độ tuổi trung bình đối tượng nghiên cứu là 57,8 ± 12,1 (tuổi), chủ yếu là nữ giới (~80%), thời gian phát hiện ILD từ khi chẩn đoán CTD là 18,1 tháng. Phân loại theo bệnh, SSc gặp nhiều nhất ở 21/49 trường hợp (42,9%), SLE gặp ở 16/49 người bệnh (32,7%), PM/DM là 9/49 trường hợp (18,4%) và thấp nhất là nhóm bệnh MCTD với 3/49 người bệnh (6,1%). Trên lâm sàng, khoảng 67,3% các trường hợp có biểu hiện ho
87,5% người bệnh khó thở khi gắng sức trong đó có 29/49 trường hợp mMRC ≥ 2
và trên 75,5% trường hợp phát hiện bất thường khi nghe phổi. Bất thường trên Xquang phổi thẳng chỉ có thể phát hiện ở 50 - 60% các trường hợp. Trên phim chụp cắt lớp vi tính độ phân giải cao (high resolution computed tomography - HRCT), kính mờ, tổ ong và giãn phế quản co kéo là các dạng tổn thương thường gặp nhất. Khi đánh giá hình thái tổn thương, viêm phổi kẽ không đặc hiệu (nonspecific interstitial pneumonia - NSIP) và viêm phổi kẽ thông thường (usual interstitial pneumonia - UIP) là hai hình thái phổ biến trong nhóm ILD-CTD. Qua nghiên cứu, chúng tôi thấy ILD có thể gặp ở hầu hết các bệnh CTD với các dạng và hình thái tổn thương khác nhau. Do đó, cần thăm khám kĩ lâm sàng và có thể chỉ định chụp HRCT sớm để tránh bỏ sót tổn thương ILD ở nhóm bệnh CTD.Our study aimed to evaluate the frequency and phenotype of interstitial lung disease (ILD) in patients diagnosed with connective tissue disease (CTD). Cross-sectional descriptive study on 49 patients with a confirmed diagnosis of CTD including systemic sclerosis (SSc), systemic lupus erythematosus (SLE), polymyositis/dermatomyositis (PM/DM) and mixed connective tissue disease (MCTD), treated at the Center for Allergy - Clinical Immunology, Bach Mai Hospital from August 2023 to February 2024. The average age of the study subjects was 57.8 ± 12.1 (years), mainly women (∼80%), ILD was definitely diagnosis after CTD at around 18.1 months. SSc is most common in 21/49 cases (42.9%), SLE in 16/49 patients (32.7%), and PM/DM is 9/49 cases (18.4%) and the lowest MCTD group with 3/49 patients (6.1%). About 67.3% of cases present with cough
87.5% of patients had difficulty breathing on exertion, including 29/49 cases of mMRC = 2
and over 75.5% of cases found ILD signs when auscultating the lungs. Abnormalities on regular chest X-ray can only be detected in 50 - 60% of cases. On HRCT, ground glass opacities, honeycombing, and traction bronchiectasis are the most common types of interstitial lesions. NSIP and UIP are two common patterns in the ILD-CTD group. We found that ILD can be seen in most CTD diseases with different morphology patterns. Therefore, a thorough clinical examination is needed and an early HRCT scan may be taken to avoid missed or delayed ILD diagnosis in the CTD group.

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