Quantitative CT Analysis of Lung Features in Patients with Polymyositis/Dermatomyositis without Interstitial Lung Disease
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摘要:
目的：比较多发性肌炎/皮肌炎（PM/DM）并发间质性肺病（ILD）患者、非ILD（Non-ILD）患者、健康对照组之间肺部定量CT的差异，为PM/DM相关间质性肺疾病的早期诊断提供生物学标记。方法：回顾性收集2014年12月至2023年10月在西安交通大学第一附属医院就诊的PM/DM住院患者391例，入组患者197例，其中ILD患者143例、Non-ILD患者54例，按年龄、性别1∶1配对纳入健康对照人群54例。所有研究对象胸部HRCT图像导入“数字肺”分析平台，测量全肺及各肺叶的肺容积、平均肺密度及肺血管体积等定量CT参数，对比3组在CT定量参数上的差异并行ROC分析。结果：PM/DM-ILD组除右肺上叶外其余肺叶肺容积较PM/DM-Non-ILD组减小，全肺及各肺叶平均密度较PM/DM-Non-ILD组增高，差异具有统计学意义；PM/DM-ILD组全肺、左右肺、双肺下叶血管体积较PM/DM-Non-ILD组减小，差异具有统计学意义；PM/DM-Non-ILD组全肺及各肺叶肺血管体积较健康对照组减小，差异具有统计学意义。ROC分析示右下肺血管体积在鉴别PM/DM-Non-ILD与健康对照及PM/DM-ILD与PM/DM-Non-ILD上具有最大的AUC值。结论：PM/DM-ILD患者、PM/DM-Non-ILD患者与健康对照组之间肺部定量CT特征具有差异，提示定量CT是反映PM/DM患者肺部病损的客观途径；PM/DM-Non-ILD组患者与健康对照组相比肺血管体积明显减少，提示肺血管体积可能是早期诊断PM/DM患者肺部损害的敏感指标。
Abstract:Objective: This study aims to analyze the lung differences between patients with interstitial lung disease (ILD) and non-interstitial (Non-ILD) diseases related to polymyositis/dermatomyositis (PM/DM) and healthy controls through quantitative computed tomography (CT) parameters. The objective is to establish a theoretical basis for early diagnosis and timely treatment of the disease. Method: A retrospective collection was conducted on 391 PM/DM patients, from December 2014 to October 2023, at the First Affiliated Hospital of Xi’an Jiaotong University. A total of 197 patients, including 143 ILD patients and 54 Non-ILD patients, were included in the study cohort. Fifty-four healthy controls were included in a 1∶1 ratio based on age and gender. All chest HRCT images of the study subjects were imported into the “Digital Lung” analysis platform, and quantitative CT parameters such as lung volume, average lung density, and pulmonary vascular volume were measured for the entire lung and each lung lobe. The differences in CT quantitative parameters among the three groups were compared, and ROC analysis was performed. Results: The lung volume in the PM/DM-ILD group decreased compared to the PM/DM-Non-ILD group, except for the right upper lobe. The average density of the entire lung and each lobe increased compared to the PM/DM-Non-ILD group, and the difference was statistically significant; The blood vessel volume of the entire lung, left and right lungs, and lower lobes of both lungs in the PM/DM-ILD group decreased compared to the PM/DM-Non-ILD group, and the difference was statistically significant. The PM/DM-Non-ILD group revealed a statistically significant decrease in the volume of pulmonary blood vessels in all lungs and lobes compared to the healthy control group. ROC analysis showed that the right lower pulmonary vascular volume exhibited the highest AUC value in distinguishing PM/DM-Non-ILD from healthy controls and PM/DM-ILD from PM/DM-Non-ILD. Conclusion: Quantitative CT features of the lungs differ significantly among PM/DM-ILD patients, PM/DM-Non-ILD patients, and healthy control groups, indicating that quantitative CT is an objective and sensitive method for evaluating lung changes in PM/DM patients. Compared with the healthy control group, patients in the PM/DM-Non-ILD group showed a significant decrease in pulmonary vascular volume, indicating that pulmonary vascular volume may be a sensitive indicator for the early detection of pulmonary damage in PM/DM patients.
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图 1 肺血管可视化
注：（a）PM/DM-Non-ILD患者肺血管；（b）健康对照肺血管。由图可看出健康对照肺血管体积较PM/DM-Non-ILD患者大，尽管HRCT图像上两者都未出现明显病变。
Figure 1. Visualization of pulmonary vascularity
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图 2 全肺及各肺叶肺血管体积箱图
注：健康对照组肺血管体积在各肺叶中最大，除双肺上叶、右中叶，PM/DM-ILD组肺血管体积均小于PM/DM-Non-ILD组。
Figure 2. Box diagrams illustrating the vascular volume in whole lung and each lobe pulmonary
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图 3 ROC分析
注：（a）PM/DM-ILD组与PM/DM-Non-ILD组ROC分析；（b）PM/DM-Non-ILD组与健康对照组ROC分析。
Figure 3. Results of the ROC analysis
表 1 人口学信息
Table 1 Demographic information
项目 组别 统计检验 PM/DM-ILD
（n=143）PM/DM-Non-ILD（n=54） 健康对照
（n=54）Pa Pb Pc 男 50 22 22 0.378 − 0.378 女 93 32 32 年龄/岁 54
（46，63）51
（40，62）48
（41，58）0.083 − 0.083 注：Pa为PM/DM-Non-ILD组与PM/DM-ILD组统计学差异，Pb为PM/DM-Non-ILD组与健康对照组统计学差异，Pc为PM/DM-ILD与健康对照组统计学差异。 
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表 2 PM/DM患者及健康对照人群WL及各肺叶肺容积检测结果（mL，M（Q1，Q3））
Table 2 Results of WL and lung volume in each lobe of PM/DM patients and healthy control populations (mL, M(Q1, Q3))
项目 组别 统计检验 PM/DM-ILD（n=143） PM/DM-Non-ILD（n=54） 健康对照（n=54） P Pa Pb Pc WL 3095.71 （2356.44 ，3813.90 ）4037.37 （3481.56 ，5219.65 ）4367.61 （3910.58 ，5118.33 ）< 0.001 < 0.001 1.000 < 0.001 RL 1684.90 （1298.73 ，2130.54 ）2254.07 （1900.67 ，2784.83 ）2302.96 （2147.36 ，2720.62 ）< 0.001 < 0.001 1.000 < 0.001 LL 1383.09 （1039.28 ，1819.33 ）1844.57 （1545.45 ，2411.04 ）2059.56 （1717.56 ，2379.34 ）< 0.001 < 0.001 1.000 < 0.001 RUL 773.70（617.43， 1012.21 ）867.21（676.69， 1072.21 ）861.98（743.23，973.54） 0.118 − − − RML 322.61（226.39，420.58） 418.86（341.18，535.37） 418.89（335.98，506.46） < 0.001 < 0.001 1.000 < 0.001 RLL 545.47（367.62，788.90） 968.89（760.84， 1209.84 ）1117.65 （936.14，1254.96 ）< 0.001 0.001 0.917 < 0.001 LUL 892.34（683.67， 1132.08 ）1047.66 （853.26，1398.61 ）1043.45 （889.32，1280.69 ）< 0.001 0.005 1.000 0.011 LLL 492.72（328.20，693.13） 858.63（639.49， 1073.65 ）1034.50 （811.00，1132.76 ）< 0.001 < 0.001 0.343 < 0.001 注：P为3组间统计学差异，Pa为PM/DM-Non-ILD组与PM/DM-ILD组统计学差异，Pb为PM/DM-Non-ILD组与健康对照组统计学差异，Pc为PM/DM-ILD与健康对照组统计学差异。
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表 3 PM/DM患者及健康对照人群WL及各肺叶肺密度相关指标比较（HU，M（Q1，Q3））
Table 3 Comparison of WL and lung density related indexes of each lobe between PM/DM patients and healthy control populations (HU, M(Q1, Q3))
项目 组别 统计检验 PM/DM-ILD（n=143） PM/DM-Non-ILD（n=54） 健康对照（n=54） P Pa Pb Pc WL −767.50（−809.60，−710.77） −814.98（−842.25，−788.08） −826.53（−840.31，−802.15） < 0.001 < 0.001 1.000 < 0.001 RL −772.16（−816.70，−716.29） −817.98（−848.18，−799.17） −827.12（−842.19，−806.59） < 0.001 < 0.001 1.000 < 0.001 LL −759.08（−801.59，−693.28） −811.81（−842.25，−788.08） −822.20（−837.93，−791.18） < 0.001 < 0.001 1.000 < 0.001 RUL −804.21（−833.00，−761.60） −832.94（−851.85，−812.90） −833.86（−844.24，−812.61） < 0.001 < 0.001 1.000 < 0.001 RML −795.86（−834.03，−737.29） −838.37（−857.78，−819.11） −837.71（−857.75，−819.39） < 0.001 < 0.001 1.000 < 0.001 RLL −706.00（−778.38，−630.13） −800.30（−833.23，−773.74） −810.19（−830.31，−781.53） < 0.001 < 0.001 1.000 < 0.001 LUL −789.90（−824.08，−739.30） −828.12（−865.27，−809.77） −825.69（−849.88，−799.76） < 0.001 < 0.001 1.000 0.030 LLL −704.54（−771.43，−597.10） −788.65（−827.02，−761.50） −801.79（−826.44，−768.86） < 0.001 < 0.001 1.000 < 0.001 注：P为3组间统计学差异，Pa为PM/DM-Non-ILD组与PM/DM-ILD组统计学差异，Pb为PM/DM-Non-ILD组与健康对照组统计学差异，Pc为PM/DM-ILD与健康对照组统计学差异。
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表 4 PM/DM患者及健康对照人群WL及各肺叶IPVV检测结果（mL，M（Q1，Q3））
Table 4 Results of WL and IPVV in each lobe of PM/DM patients and healthy control populations (mL, M(Q1, Q3))
项目 组别 统计检验 PM/DM-ILD（n=143） PM/DM-Non-ILD（n=54） Control（n=54） P Pa Pb Pc WL 87.30（62.89，124.35） 113.80（76.48，158.84） 182.08（142.73，216.57） < 0.001 0.027 < 0.001 < 0.001 RL 47.57（35.66，67.80） 61.60（42.16，85.51） 97.36（77.00，115.93） < 0.001 0.023 < 0.001 < 0.001 LL 42.47（28.65，59.25） 50.66（34.45，73.74） 82.14（66.35，98.57） < 0.001 0.035 < 0.001 < 0.001 RUL 22.62（14.97，32.17） 20.02（13.73，27.23） 32.15（25.23，39.00） < 0.001 1.000 < 0.001 < 0.001 RML 7.11（4.50，12.64） 9.57（5.64，14.67） 14.97（11.72，17.87） < 0.001 0.129 < 0.001 < 0.001 RLL 15.30（6.56，26.73） 31.47（17.65，43.93） 48.69（39.46，58.64） < 0.001 < 0.001 < 0.001 < 0.001 LUL 23.87（16.79，36.40） 26.22（16.33，33.94） 38.93（29.35，46.04） < 0.001 1.000 < 0.001 < 0.001 LLL 13.93（7.61，25.60） 24.59（15.96，38.80） 43.06（35.60，52.01） < 0.001 < 0.001 < 0.001 < 0.001 注：P为3组间统计学差异，Pa为PM/DM-Non-ILD组与PM/DM-ILD组统计学差异，Pb为PM/DM-Non-ILD组与健康对照组统计学差异，Pc为PM/DM-ILD与健康对照组统计学差异。
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表 5 PM/DM-Non-ILD 患者组与PM/DM-ILD患者组的ROC曲线结果分析
Table 5 Analysis of ROC curve results between PM/DM-Non-ILD and PM/DM-ILD patients
肺部区域 AUC 标准误 P 约登指数 敏感度/% 特异度/% 95% CI WL 0.641 0.043 < 0.001 0.245 56.6 68.5 0.557~0.727 RL 0.644 0.043 < 0.001 0.252 56.6 68.5 0.559~0.728 LL 0.638 0.043 < 0.001 0.210 26.6 94.4 0.554~0.722 RLL 0.751 0.035 < 0.001 0.408 42.7 98.1 0.683~0.820 LLL 0.737 0.035 < 0.001 0.406 46.2 94.4 0.667~0.807
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表 6 PM/DM-Non-ILD 患者组与健康对照组的ROC曲线结果分析
Table 6 Analysis of ROC curve results for PM/DM-Non-ILD patients versus healthy controls
肺部区域 AUC 标准误 P 约登指数 敏感度/% 特异度/% 95% CI WL 0.801 0.042 < 0.001 0.4815 92.6 55.6 0.719~0.883 RL 0.799 0.042 < 0.001 0.4630 92.6 53.7 0.716~0.882 LL 0.803 0.041 < 0.001 0.4815 92.6 55.6 0.722~0.884 RUL 0.778 0.045 < 0.001 0.4815 72.2 75.9 0.689~0.867 RML 0.737 0.048 < 0.001 0.3889 98.1 40.7 0.642~0.831 RLL 0.823 0.039 < 0.001 0.5000 87.0 63.0 0.746~0.900 LUL 0.777 0.044 < 0.001 0.4259 70.4 72.2 0.690~0.863 LLL 0.814 0.041 < 0.001 0.5741 90.7 66.7 0.734~0.895
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