Investigation Of Clinical Characteristics And Serum Marker Detection Of CTD-ILD

BackgroundConnective tissue diseases are sorts of chronic autoimmune disease with diverse clinical manifestation. Intestinal lung disease is common in connective tissue disease.With inflammation and fibroplasias, it reduces the lung function and then increases mortality. American Thoracic Society-European Respiration Association Congress presented the Pathology Classification Diagnosis Criteria of intestinal lung disease in 2013. The idiopathic interstitial pneumonia were divided into three broad categories, and eight types.However, connective tissue disease with intestinal lung disease still kept in secret to both rheumatologists and pulmonologist for its various clinical manifestation and complex eikonic and pathologic representation. Clinical-radiologic-histological combine diagnosis is the dawn of CTD-ILD diagnosis. The early start immunosuppressant therapy of ILD can prevent alveolitis progress to end-stage irreversible fibrosis,obviously improve prognosis,so to find Serum marker to prediction CTD-ILD, evaluating the disease activity and disease severity isimportant significance to improve prognosis.This study was designed according to this principle. To understand the clinical, imaging, and pathological features of connective tissue diseases with interstitial lung disease. To investigate the relationship between imaging and pathological types. This study also detected Serum markers-krebs von den lungen-6, surfactant protein A, surfactant protein D(KL-6,SP-A,SP-D) in the serum of CTD patients, analysis the significance of the serum markers in diagnosis of connective tissue diseases with interstitial lung disease and assessment of disease activity.Objective1. Observe the clinical manifestation, laboratory tests,imageology feature, pulmonary function test, pathology in CTD-ILD, and search the relationship between them.2. To explore the possible diagnostic values of KL-6,SP-A,SP-D for connective tissue diseases with interstitial lung disease.Methods1.Sieved 325 CTD-ILD patients by international received CTD standard and Clinical-radiologic-histological combine diagnosis of interstitial lung diseases.1.lObserved incidence, clinical manifestation and laboratory data.1.2Quantified the imageology feature of different CTD-ILD under HRCT.Correlation analysis was carried out to analyse the relationship between imageology and clinical manifestation/pulmonary function test/pathology.1.3Applied CT-guided needle percutaneous lung biopsy in ILD-CTD. Reviewed the pathologic changes with light microscope. Correlation analysis was performed to analyze the relationship between pathology and clinical manifestations/imageology.2.Sieved 75 CTD patients by international received CTD standard and Clinical-radiologic-histological combine diagnosis of interstitial lung diseases. Divided into two groups, CTD with ILD group and CTD without ILD group.2.1 To compare the serum levels of KL-6,SP-A,SP-D between the CTD with ILD group and CTD without ILD group.2.2Correlation analysis was performed to analyze the relationship between imageology types and the serum levels of KL-6,SP-A,SP-D.2.3Correlation analysis was performed to analyze the relationship between imageology levels and the serum levels of KL-6,SP-A,SP-D.2.4To compare the serum levels of KL-6,SP-A,SP-D between the ILD activities group and ILD without activities group.2.5Correlation analysis was carried out to analyse the relationship between ESR/CRP/FVC/DLCO and the serum levels of KL-6,SP-A,SP-D.Results1.1 Clinical Manifestations:The clinical symptoms of CTD-ILD are often difference. Routine laboratory examination can hardly diagnose CTD-ILD in early stage.1.2Imageology:The image of CTD-ILD under HRCT was multiform and changeable. Two and above kinds of portrait were common in the patients. There was significant difference between different diseases. The graticule,honeycomb and consolidation were common in SSc/RA/DM, SSc/RA,PM/SLE,respectively.1.3CT-guided needle percutaneous lung biopsy in CTD-ILD was proved to be successful safe. Correlation analysis was performed to analyze the relationship between imageology types and pathological types,there are no significant difference between the two methods of diagnosis.2.1The serum levels of KL-6,SP-A,SP-D in the CTD with ILD were all significantly higher than CTD without ILD.2.2There are no significant difference between the imageology types and the serum levels of KL-6,SP-A,SP-D.2.3There are significant difference between the imageology levels and the serum levels of KL-6,SP-D.2.4The serum levels of KL-6,SP-D in the ILD activities group were all significantly higher than ILD without activities group.2.5There are no significant difference between ESR/CRP/FVC/DLCO and the serum levels of KL-6,SP-A,SP-D.Conclusion1.Different incidences in different CTD-ILD, clinical features and imaging also vary. CT-guided needle percutaneous lung biopsy pathology is considerable and accurate approach to early diagnosis of CTD-ILD. HRCT possesses high sensitivity to CTD-ILD diagnosis and value of therapeutic effect evaluation,maybepredict the pathological types.2.KL-6, SP-A and SP-D may be potential useful serum markers for diagnosis of CTD-ILD.It is significant for KL-6, SP-D to diagnose CTD-ILD and assess ILD lesion severity and disease activity.