2019 年第 7 期 第 14 卷

肺功能检测在儿童系统性红斑狼疮和幼年型皮肌炎所致肺损伤中的应用研究

Pulmonary function detection in lung injury caused by juvenile systemic lupus erythematosus and juvenile dermatomyositis

作者：王亚军赖建铭侯冬青李硕宋欣

英文作者：

单位：100020北京，首都儿科研究所呼吸内科（王亚军），风湿免疫科（赖建铭），流行病学研究室（侯冬青），肺功能室（李硕、宋欣）

英文单位：

关键词：肺损伤；系统性红斑狼疮；皮肌炎；儿童

英文关键词：

• 摘要：

• 【摘要】目的    探讨肺功能特别是一口气呼吸法肺一氧化碳弥散功能（DLCO-SB）检测在儿童系统性红斑狼疮和幼年型皮肌炎所致肺损伤中的应用价值。方法    完全随机选取2016年5月至2018年12月在首都儿科研究所住院的60例患儿作为观察组，其中儿童系统性红斑狼疮40例、幼年型皮肌炎20例。使用随机抽样方法，在同期入院符合肺炎诊断的患儿中，按照与观察组同年龄匹配原则随机抽取63例患儿作为对照组。对所有患儿进行肺通气功能、气道阻力、DLCO-SB、肺部高分辨率CT（HRCT）等检查。对肺功能检查结果与临床表现、HRCT结果进行比较分析。结果    在观察组60例患儿中，DLCO-SB异常率高于呼吸系统症状体征出现率［53.3%（32/60）比16.7%（10/60）］，差异有统计学意义（χ2=17.729，P<0.001）。观察组HRCT结果异常的有22例（36.7%），其中肺磨玻璃影9例、小片影8例、胸膜腔积液7例；观察组DLCO-SB异常率高于HRCT异常率，差异有统计学意义（χ2=17.045，P<0.001）。观察组DLCO-SB异常检出率高于对照组［11.1%（7/63）］，差异有统计学意义（χ2=25.301，P<0.001）。在观察组38例HRCT未见异常的患儿中发现了15例患儿DLCO-SB<预计值的80%，为（136±29）%，异常率为39.5%。结论    儿童系统性红斑狼疮和幼年型皮肌炎的间质性肺病肺功能表现为弥散功能降低及限制性通气功能障碍。对于儿童系统性红斑狼疮和幼年型皮肌炎所致的间质性肺病，DLCO-SB比HRCT更敏感。肺功能检测对间质性肺病和肺部感染有一定鉴别意义。

• 【Abstract】Objective    To investigate the value of diffusion capacity for carbon monoxide of lung tested by single breath（DLCO-SB） in lung injury caused by juvenile systemic lupus erythematosus and juvenile dermatomyositis. Methods    From May 2016 to December 2018, 40 cases of juvenile systemic lupus erythematosus and 20 cases of juvenile dermatomyositis were randomly enrolled from Capital Institute of Pediatrics as observation group; 63 children with pneumonia matched by age were enrolled as control group. All children were detected pulmonary ventilation, airway resistance, DLCO-SB and lung high-resolution CT(HRCT). Results     of pulmonary function tests, clinical manifestations and HRCT findings were analyzed. Results    Among the 60 children in observation group, abnormal rate of DLCO-SB was significantly higher than that of respiratory symptoms and signs［53.3%(32/60) vs 16.7%(10/60)］(χ2=17.729, P<0.001). Twenty-two children showed abnormal lung HRCT results in observation group, including 9 cases of ground-glass opacity, 8 cases of small opacity and 7 cases of pleural effusion; abnormal rate of DLCO-SB was significantly higher than that of HRCT［36.7%（22/60）］（χ2=17.045， P<0.001）. Abnormal rate of DLCO-SB in observation group was significantly higher than that in control group［11.1%(7/63)］(χ2=25.301, P<0.001). In observation group, 38 children without abnormal HRCT findings had DLCO-SB lower than 80% of the predicted value; the mean value was (136±29)%; the abnormal rate was 39.5%. Conclusions    Juvenile systemic lupus erythematosus and juvenile dermatomyositis can induce interstitial lung disease, which mainly manifests as diffusion capacity reduction and restrictive ventilatory function disturbance. DLCO-SB has a higher sensitivity than HRCT in the diagnosis of interstitial lung disease. Pulmonary function detection shows certain differential diagnostic value for interstitial lung disease and pulmonary infection.