目的:间质性肺病(ILD)在类风湿关节炎(RA)患者中常见,并与显著的发病率和死亡率相关。这篇综述的目的是确定RA患者ILD的不同筛查方法。
方法:我们在Pubmed中进行了系统搜索,Embase和Cochrane图书馆截至2020年4月,并手动搜索了检索到的文章的参考文献。搜索仅限于人类和以英语发表的文章,西班牙语或法语。我们选择了任何设计的研究,其中:(a)人群包括成年RA患者;(b)干预是任何ILD筛查方法;(c)评估筛查方法的有效性或可靠性。或描述了一种筛选方法。两名审阅者通过标题和摘要独立筛选文章,然后使用特定的数据提取表提取信息。
结果:纳入25项研究,共2593例患者。最常用的ILD筛查工具是肺的高分辨率计算机断层扫描(HRCT)。电子听诊,生化标志物,支气管肺泡灌洗(BAL),还评估了肺功能检查(PFTs)和肺部超声检查.在不同的研究中,电子听诊和肺部超声检查的准确性高于PFTs,BAL和生化标记。
结论:HRCT是RA患者ILD筛查最敏感的工具。鉴于其无害性和高灵敏度,肺部超声检查可能成为未来的首选工具。
OBJECTIVE: Interstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. The aim of this
review was to identify the different screening methods for ILD in patients with RA.
METHODS: We ran a systematic search in Pubmed, Embase and Cochrane Library up to April 2020 and did a hand search of the references of the retrieved articles. The search was limited to humans and articles published in English, Spanish or French. We selected studies with any design where: (a) the population included adult patients with RA; (b) the intervention was any screening method for ILD; and (c) validity or reliability of the screening method were evaluated, or a screening method was described. Two reviewers independently screened the articles by title and abstract and subsequently extracted the information using a specific data extraction form.
RESULTS: 25 studies were included with a total of 2593 patients. The most frequently used tool for ILD screening was high resolution computed tomography (HRCT) of the lung. Electronic auscultation, biochemical markers, bronchoalveolar lavage (BAL), pulmonary function tests (PFTs) and lung ultrasonography were also evaluated. Across the different studies, electronic auscultation and lung ultrasonography achieved higher accuracy than PFTs, BAL and biochemical markers.
CONCLUSIONS: HRCT resulted as the most sensitive tool for ILD screening in patients with RA. Given its harmlessness and high sensitivity, lung ultrasonography may become the first-choice tool in the future.