Sistemik skleroz hastalarında epikardiyal yağ volümü ile parankim bulgularının karşılaştırılması
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Tarih
2023
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada sistemik skleroz (SSc) hastalarında epikardiyal yağ volümlerinin, interstisyel akciğer hastalığı (İAH) varlığı ve akciğer tutulum bulguları tarafından belirlenen hastalığın şiddeti ve yaygınlığı ile ilişkisi olup olmadığının belirlenmesi amaçlanmıştır. Bu şekilde epikardiyal yağ volümünün akciğer tutulum bulguları tarafından belirlenen hastalık şiddeti açısından potansiyel bir görüntüleme bulgusu olarak kullanılıp kullanılamayacağının da belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi Romatoloji polikliniğine 01.01.2020 ile 30.06.2022 tarihleri arasında başvurmuş olan 45 (40 kadın, 5 erkek, ortalama yaş 53,4) SSc hastası ve yine aynı tarihler arasında polikliniğe başvuru yapmış ve herhangi bir romatolojik hastalık tanısı ve koroner arter hastalığı tanısı konulmayan 30 (25 kadın, 5 erkek, ortalama yaş 51,033) hasta kontrol grubu çalışmaya dahil edildi. Hasta dosyalarından ve hastanenin elektronik bilgi sisteminden elde edilen hastalara ait demografik, klinik ve laboratuvar özellikler retrospektif olarak değerlendirildi. Çekilen Toraks BT görüntülerinde saptanan akciğer parankim bulgularına göre hesaplanan, akciğer tutulum skoru olarak Warrick skoru için gerekli veriler kaydedildi ve skor hesaplandı. Çekilen Toraks BT görüntülerinde epikardiyal yağ volümü ölçümü ücretsiz ve halka açık 3D Slicer programı kullanılarak yapıldı. Çekilen Toraks BT’de saptanan ek bulgular kaydedildi.
Bulgular: SSc hastalarının 25’inde (%55) BT’de İAH saptandı. İAH olan hastaların yaş ortalaması 58, İAH olmayan hastaların yaş ortalaması 47,65 olarak bulundu. İAH olan hastaların yaş ortalamasının, İAH olmayan hastalara ve kontrol grubuna göre daha yüksek olduğu saptandı.
Warrick skoru kullanılarak skorlanan, en sık görülen parankim bulguları septal/subplevral çizgilenmeler (%96) ve plevral kenarlarda düzensizlik (%96) idi. BT’de en sık saptanan İAH formu nonspesifik interstisyel pnömoni (%84) idi.
v
Çalışmamızdaki hastaların skorlarının ortalaması şiddet skoru için 5,88 ± 2,53837, yaygınlık skoru için 6,8 ± 1,73205, alveolar indeks için 1,32 ± 1,81934, fibrozis indeksi için 11,36 ± 4,10163, total Warrick skoru için 12,68 ± 3,90214 olarak bulundu.
Epikardiyal yağ volümü ortalaması SSc hastalarında 72,4441 ± 45,26306 cm³, İAH olan hastalarda 84,8191 ± 48,90193 cm³, İAH olmayan hastalarda 56,9754 ± 35,64222 cm³ kontrol grubunda 41,7268 ± 21,79251 cm³ olarak saptandı.
SSc hastalarında ölçülen epikardiyal yağ volümleri kontrol grubuna göre anlamlı olarak daha yüksek bulundu (p<0,001). İAH olan hastalardaki epikardiyal yağ volümlerinin, İAH olmayan hastalara ve kontrol grubuna göre anlamlı olarak daha yüksek olduğu saptandı (p<0,001). Epikardiyal yağ volümleri ile İAH’nin şiddet skoru, yaygınlık skoru, total Warrick skoru, alveolar indeks ve fibrozis indeksi ile arasında anlamlı korelasyon saptanmadı (p>0,05).
İAH olan grupta total Warrick skoru ile hastanın kreatinin değeri (0,7268 ± 0,16155 mg/dL) arasında orta derecede pozitif anlamlı korelasyon saptandı (r=0,403, p=0,045).
İAH olan grupta anti-scl 70 antikor pozitifliği (%80), İAH olmayan gruba göre (%30) anlamlı olarak daha fazla bulundu (chi-square=10,90, p<0,001). İAH olan grupta en geniş özofagus çapı (28,68 ± 13,03112 cm), kanda lökosit sayısı (8,9752 ± 3,36933 10^3/uL), kanda nötrofil sayısı (6,44 ± 2,8482 10^3/uL), kanda platelet sayısı (302,44 ± 89,03795 10^3/uL), modifiye Rodnan cilt skoru (22,2 ± 13,94931), ekokardiyografi ile ölçülen pulmoner arter basıncı (38,36 ± 10,18937 mmHg) ve tanı yaşı (52,12 ± 12,02192), İAH olmayan gruptaki en geniş özofagus çapına (16,15 ± 5,67798 cm), kanda lökosit sayısına (6,6585 ± 1,74847 10^3/uL), kanda nötrofil sayısına (4,3715 ± 1,59150 10^3/uL), kanda platelet sayısına (247,7 ± 74,70651 10^3/uL), modifiye Rodnan cilt skoruna (12,45 ± 10,40989), ekokardiyografi ile ölçülen pulmoner arter basıncına (31,4 ± 6,97665 mmHg) ve tanı yaşına (43,85 ± 11,41686) göre anlamlı olarak daha yüksek bulundu (p<0,05).
Sonuç: Çalışmamızda artmış epikardiyal yağ volümleri ile SSc varlığı arasında ve sistemik sklerozlu hastalarda görülen İAH varlığı arasında anlamlı istatistiksel ilişki bulunmuştur. Ancak akciğer parankim tutulumunun şiddeti ve yaygınlığı ile epikardiyal yağ volümleri arasında bu çalışmada korelasyon saptanmamıştır.
Purpose: The aim of this study was to determine whether epicardial fat volumes, in patients with systemic sclerosis (SSc), are associated with the presence of interstitial lung disease and the severity and extent of the disease defined by the findings of pulmonary involvement. Thus, it was aimed to determine whether epicardial fat volume could be used as a potential imaging marker for the severity of the disease defined by the findings of pulmonary involvement. Materials and Methods: In this study, 45 (40 females, 5 males, mean age 53,4 years) SSc patients who applied to Necmettin Erbakan University Meram Faculty of Medicine Rheumatology Outpatient Clinic between the dates 01.01.2020-30.06.2022, and 30 (25 females, 5 males, mean age 51,033 years) controls who applied to the polyclinic between the same dates and weren't diagnosed with any rheumatological diseases and coronary artery disease were included. Demographic, clinical and laboratory findings of patients obtained from patient files and electronic medical records of the hospital were evaluated retrospectively. In this study, the necessary data to calculate Warrick score, which was used to assess pulmonary involvement based on lung parenchymal abnormalities detected on thorax CT scans, were recorded and the score was calculated. Epicardial fat volume was measured, using the free and publicly available 3D Slicer program, on thorax CT images. Additional CT findings were recorded. Results: Interstitial lung disease was detected in 25 (55%) of SSc patients on CT. The mean age of patients with interstitial lung disease was 58, and the mean age of patients without interstitial lung disease was 47,65. The mean age of patients with interstitial lung disease was found to be higher than those without interstitial lung disease and the controls. The most common parenchymal findings, scored using the Warrick score, were septal/subpleural lines (96%) and irregular pleural margins (96%). The most common form of interstitial lung disease detected on CT was nonspecific interstitial pneumonia (84%). vii The mean scores of the patients involved in our study were 5,88 ± 2,53837 for the severity score, 6,8 ± 1,73205 for the extent score, 1,32 ± 1,81934 for the alveolar index, 11,36 ± 4,10163 for the fibrosis index, 12,68 ± 3,90214 for the total Warrick score. The mean epicardial fat volume was 72,4441 ± 45,26306 cm³ in SSc patients, 84,8191 ± 48,90193 cm³ in patients with interstitial lung disease, 56,9754 ± 35,64222 cm³ in patients without interstitial lung disease, and 41,7268 ± 21,79251 cm³ in controls. Epicardial fat volumes measured in SSc patients were found to be significantly higher than in the controls (p<0,001). Epicardial fat volumes in patients with interstitial lung disease were found to be significantly higher than in patients without interstitial lung disease and the controls (p<0,001). There was no significant correlation between epicardial fat volumes and the calculated scores (the severity score, the extent score, the total Warrick score, the alveolar index, the fibrosis index) of interstitial lung disease (p>0,05). A moderately positive significant correlation was found between the total Warrick score and the patient's creatinine value (0,7268 ± 0,16155 mg/dL) in the group with interstitial lung disease (r=0,403, p=0,045). Anti-Scl 70 antibody positivity (80%) was significantly higher in the group with interstitial lung disease than in the group without interstitial lung disease (30%) (chi-square=10,90, p<0,001). The widest esophageal diameter (28,68 ± 13,03112 cm), blood leukocyte count (8,9752 ± 3,36933 10^3/uL), blood neutrophil count (6,44 ± 2,8482 10^3/uL), blood platelet count (302.44 ± 89,03795 10^3/uL), modified Rodnan skin score (22,2 ± 13,94931), echocardiographic measurement of pulmonary artery pressure (38,36 ± 10,18937 mmHg) and the age at diagnosis (52,12 ± 12,02192) were found to be significantly higher in patients with interstitial lung disease than the widest esophageal diameter (16,15 ± 5,67798 cm), blood leukocyte count (6,6585 ± 1,74847 10^3/uL), blood neutrophil count (4,3715 ± 1,59150 10^3/uL), blood platelet count (247,7 ± 74,70651 10^3/uL), modified Rodnan skin score (12,45 ± 10,40989), echocardiographic measurement of pulmonary artery pressure (31,4 ± 6,97665 mmHg) and the age at diagnosis (43,85 ± 11,41686) in patients without interstitial lung disease (p<0,05). Conclusions: In our study, a statistically significant association was found between increased epicardial fat volumes and the presence of SSc, as well as with the presence of interstitial lung disease in patients with SSc. However, no correlation was found between epicardial fat volumes and the severity or extent of interstitial lung disease in this study.
Purpose: The aim of this study was to determine whether epicardial fat volumes, in patients with systemic sclerosis (SSc), are associated with the presence of interstitial lung disease and the severity and extent of the disease defined by the findings of pulmonary involvement. Thus, it was aimed to determine whether epicardial fat volume could be used as a potential imaging marker for the severity of the disease defined by the findings of pulmonary involvement. Materials and Methods: In this study, 45 (40 females, 5 males, mean age 53,4 years) SSc patients who applied to Necmettin Erbakan University Meram Faculty of Medicine Rheumatology Outpatient Clinic between the dates 01.01.2020-30.06.2022, and 30 (25 females, 5 males, mean age 51,033 years) controls who applied to the polyclinic between the same dates and weren't diagnosed with any rheumatological diseases and coronary artery disease were included. Demographic, clinical and laboratory findings of patients obtained from patient files and electronic medical records of the hospital were evaluated retrospectively. In this study, the necessary data to calculate Warrick score, which was used to assess pulmonary involvement based on lung parenchymal abnormalities detected on thorax CT scans, were recorded and the score was calculated. Epicardial fat volume was measured, using the free and publicly available 3D Slicer program, on thorax CT images. Additional CT findings were recorded. Results: Interstitial lung disease was detected in 25 (55%) of SSc patients on CT. The mean age of patients with interstitial lung disease was 58, and the mean age of patients without interstitial lung disease was 47,65. The mean age of patients with interstitial lung disease was found to be higher than those without interstitial lung disease and the controls. The most common parenchymal findings, scored using the Warrick score, were septal/subpleural lines (96%) and irregular pleural margins (96%). The most common form of interstitial lung disease detected on CT was nonspecific interstitial pneumonia (84%). vii The mean scores of the patients involved in our study were 5,88 ± 2,53837 for the severity score, 6,8 ± 1,73205 for the extent score, 1,32 ± 1,81934 for the alveolar index, 11,36 ± 4,10163 for the fibrosis index, 12,68 ± 3,90214 for the total Warrick score. The mean epicardial fat volume was 72,4441 ± 45,26306 cm³ in SSc patients, 84,8191 ± 48,90193 cm³ in patients with interstitial lung disease, 56,9754 ± 35,64222 cm³ in patients without interstitial lung disease, and 41,7268 ± 21,79251 cm³ in controls. Epicardial fat volumes measured in SSc patients were found to be significantly higher than in the controls (p<0,001). Epicardial fat volumes in patients with interstitial lung disease were found to be significantly higher than in patients without interstitial lung disease and the controls (p<0,001). There was no significant correlation between epicardial fat volumes and the calculated scores (the severity score, the extent score, the total Warrick score, the alveolar index, the fibrosis index) of interstitial lung disease (p>0,05). A moderately positive significant correlation was found between the total Warrick score and the patient's creatinine value (0,7268 ± 0,16155 mg/dL) in the group with interstitial lung disease (r=0,403, p=0,045). Anti-Scl 70 antibody positivity (80%) was significantly higher in the group with interstitial lung disease than in the group without interstitial lung disease (30%) (chi-square=10,90, p<0,001). The widest esophageal diameter (28,68 ± 13,03112 cm), blood leukocyte count (8,9752 ± 3,36933 10^3/uL), blood neutrophil count (6,44 ± 2,8482 10^3/uL), blood platelet count (302.44 ± 89,03795 10^3/uL), modified Rodnan skin score (22,2 ± 13,94931), echocardiographic measurement of pulmonary artery pressure (38,36 ± 10,18937 mmHg) and the age at diagnosis (52,12 ± 12,02192) were found to be significantly higher in patients with interstitial lung disease than the widest esophageal diameter (16,15 ± 5,67798 cm), blood leukocyte count (6,6585 ± 1,74847 10^3/uL), blood neutrophil count (4,3715 ± 1,59150 10^3/uL), blood platelet count (247,7 ± 74,70651 10^3/uL), modified Rodnan skin score (12,45 ± 10,40989), echocardiographic measurement of pulmonary artery pressure (31,4 ± 6,97665 mmHg) and the age at diagnosis (43,85 ± 11,41686) in patients without interstitial lung disease (p<0,05). Conclusions: In our study, a statistically significant association was found between increased epicardial fat volumes and the presence of SSc, as well as with the presence of interstitial lung disease in patients with SSc. However, no correlation was found between epicardial fat volumes and the severity or extent of interstitial lung disease in this study.
Açıklama
Anahtar Kelimeler
Sistemik Skleroz, Epikardiyal Yağ Volümü, Epikardiyal Adipoz Doku, İnterstisyel Akciğer Hastalığı, Bilgisayarlı tomografi, Systemic Sclerosis, Epicardial Fat Volume, Epicardial Adipose Tissue, Interstitial Lung Disease, Computed Tomography
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Scopus Q Değeri
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Künye
Garipoglu. C. (2023). Sistemik skleroz hastalarında epikardiyal yağ volümü ile parankim bulgularının karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Nöroloji Anabilim Dalı, Konya.
