Sarkoidozlu hastalarda toraks BT şiddet skorunun SFT,DLCO ve 6DYT ile ilişkisi
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Sarkoidoz; pek çok organda granülomatöz reaksiyon oluşması ile karakterize,
henüz etiyolojisi tam olarak bilinmeyen multisistemik bir hastalıktır. İntratorasik tutulum;
simetrik bilateral hiler lenfadenopati ve/veya diffüz akciğer mikronodülleri %90 hastada
görülür ve özellikle en çok etkilenen sistem olan lenfatik yapılar boyunca kendini gösterir.
Bilgisayarlı tomografi (BT); lenfadenopati ve parankimal anormalliklerin tespitinde akciğer
grafisine kıyasla daha hassastır. Bu nedenle diffüz parankimal akciğer hastalıklarının tanı ve
takibinde uzun süredir Toraks BT kullanılmaktadır. Solunum Fonksiyon Testi (SFT)
fonksiyonel bozukluğu belirlemede ve hastalık progresyonunun takibinde, tedavi aşamalarının
değerlendirilmesinde kullanılan önemli bir testtir. Karbon monoksit difüzyon testi (DLCO)
alveolar gaz değişim kabiliyetini gösterir. Sarkoidoz ve benzeri interstisyel akciğer
hastalıklarında alveolokapiller membran yüzey alanı, gelişebilen parankimal tutulum ve
fibrozis nedeniyle azalabileceğinden DLCO’da düşme görülebilir. 6 dakika yürüme testi
(6DYT) hastaların fonksiyonel kapasitesini belirlemek için sıklıkla kullanılan güvenilir bir
yöntemdir.
Amaç: Bu çalışmada amaç; sarkoidozlu hastaların takibinde daha önce kullanımı
standart haline gelmemiş olan Toraks BT Şiddet Skoru (TBŞS) ile SFT, DLCO ve 6DYT
parametreleri arasındaki ilişkiyi araştırmak ve 1961’den bu yana kullanılmakta olan akciğer
grafi tabanlı scadding evreleme sistemi ile kıyaslamaktır.
Yöntem: Çalışmaya Necmettin Erbakan Üniversitesi Tıp Fakültesi Hastanesi Göğüs
Hastalıkları Anabilim Dalı Servisinde ocak 2015 - mayıs 2024 arasında yatarak tetkik ve
takibi yapılmış olan 243 sarkoidozlu hastadan hastane kayıtlarında; eş zamanlı (en fazla 3 ay
aralığında) akciğer grafisi, toraks BT’si, SFT, DLCO ve 6DYT’si olup 18 yaş üzeri 60 hasta
dahil edildi. Çalışmaya dahil edilen hastaların dosyaları retrospektif olarak incelendi.
Demografik verileri (yaş, cinsiyet, ek hastalık), toraks BT şiddet skorları, scadding evreleri,
SFT’deki FVC, FVC%, FEV1, FEV1%, FEV1/FVC, PEF, FEF 25-75, FEF 25-75%,
difüzyon kapasitesi ölçümünde DLCO ve DLCO/VA, 6DYT’deki başlangıç SPO2, bitiş
SPO2, desatürasyon yüzdesi, yürüme mesafesi ve yürünen mesafesinin beklenen mesafeye
oranları (6DYT%) kaydedildi. Bu parametrelerle TBŞS ve Scadding evrelemesi arasındaki
koralesyonlara ayrı ayrı bakılıp bu iki evreleme sisteminin birbirine üstün ve zayıf yönleri
araştırıldı. Verilerin analizinde SPSS programı kullanıldı. Sonuçlar %95’lik güven aralığında,
anlamlılık p< 0,05 düzeyinde değerlendirildi.
Bulgular: Toraks BT şiddeti skoru (TBŞS) ile FEV1(%), FVC(%), DLCO, 6DYT
bitiş satürasyonu, ve 6DYT(%) sonuçları arasında negatif yönde orta derecede anlamlı
korelasyon tespit edildi (sırasıyla; r=-0,441; p<0,001; r=-0,477; p<0,001; r=-0,522; p<0,001;
r=-0,417; p=0,001; r=-0,511; p<0,001). TBŞS ile başlangıç satürasyonu arasında düşük
derecede negatif yönde ilişki belirlendi (r=-0,296; p=0,022). TBŞS ile desatürasyon arasında
pozitif yönde, 6DYT mesafesi arasında negatif yönde düşük-orta düzeyde ilişki saptandı
(r=0,370; p=0,004; r=-0,341; p=0,008). TBŞS ile FEV1, FVC, FEV1/FVC, PEF, FEF 25-75,
FEF 25-75, DLCO/VA arasında anlamlı korelasyon saptanmadı (sırasıyla; r=-0,194; p<0,138;
r=-0,210; p<0,108; r=-0,156; p<0,233; r=-0,109; p=0,413; r=-0,019; p<0,886; r=-0,078;
p=0,553; r=-0,242; p<0,062 ).
Scadding evrelerine göre yapılan korelasyon analizinde evre arttıkça FEV1(%) ve
FVC(%) değerleri azalmaktaydı. FEV1(%) ile negatif yönde düşük derecede ve FVC(%) ile
negatif yönde düşük-orta derecede anlamlı korelasyon saptandı(sırasıyla; r=-0,29; p=0,010;
r=-0,368; p=0,001). Scadding evreleri arttıkça DLCO ve DLCO/VA değerleri de
azalmaktaydı. Scadding evreleriyle DLCO değerinde negatif yönde orta derecede ve
DLCO/VA ile negatif yönde düşük-orta derecede anlamlı korelasyon bulundu (sırasıyla; r=-
0,493; p<0,001; r=-0,331; p=0,001). Scadding evreleri arttıkça başlangıç oksijen satürasyon,
bitiş oksijen satürasyon değerleri azalmakta, desatürasyon değerleri artmaktaydı. Scadding
evreleriyle başlangıç oksijen satürasyon değeri arasında negatif yönde orta dereceli, bitiş
oksijen satürasyonunda negatif yönde orta dereceli anlamlı korelasyon ve desatürasyon
değerleri ile pozitif yönde düşük-orta derecede anlamlı korelasyon kaydedildi (sırasıyla; r=-
0,467; p=0,013; r=-0,501; p=0,016; r=0,374; p=0,002). Scadding evreleri arttıkça 6DYT (m)
ve 6DYT (%) değerleri azalmaktaydı. Scadding evreleriyle 6DYT mesafesi(m) ve 6DYT
mesafesi (%) değerleri arasında negatif yönde orta dereceli anlamlı korelasyon bulundu
(sırasıyla; r=-0,470; p=0,003; r=-0,462 p=0,034).
Scadding evrelemesi ile toraks BT şiddet skoru kıyaslandığında FEV1(%), FVC(%),
DLCO, 6DYT(%) verilerinin TBŞS ile daha yüksek korelasyonda olduğu belirlenmiştir.
FEV1, FVC, FEV1/FVC, DLCO/VA, başlangıç SpO2, bitiş SpO2, desatürasyon, 6DYT
mesafesi verilerinin Scadding evresi ile daha yüksek korelasyonda olduğu belirlenmiştir.
Sonuç: Çalışmamız, sarkoidozun akciğer tutulumunun şiddetinin radyolojik olarak
derecelendirilebildiği TBŞS ile fonksiyonel parametrelerin hemen hemen tamamına yakınıyla
anlamlı korelasyonlar gösterdiğini tespit etmiş olup TBŞS’nun FEV1(%), FVC(%), DLCO,
6DYT(%) verileri ile korelasyon konusunda Scadding evreleme sistemine üstün olduğunu
bulmuştur. Bu nedenle TBŞS sarkoidozlu hastaların takibinde göz önünde bulundurulmalıdır.
Scadding evreleme sistemine bir alternatif yada iki sistemin modifiye edilerek ortak yeni bir
evreleme sistemine geçiş için kapı arayabilir. Bu konuda çalışmamızın benzeri daha geniş
olgu serili çok merkezli çalışmalara ihtiyaç vardır.
Introduction: Sarcoidosis is a multisystemic disease characterized by the formation of granulomatous reactions/inflamattions in multiple organs, with an unkonwn etiology. Intrathoracic involvement, manifesting as symmetrical bilateral hilar lymphadenopathy and/or diffuse pulmonary micronodules, is observed in 90% of patients, predominantly affecting lymphatic structures, which are the most commonly involved system. Computed tomography (CT) is more sensitive than chest radiography for detecting lymphadenopathy and parenchymal abnormalities. Consequently, Thoracic CT has been extensively used in the diagnosis and follow-up of diffuse parenchymal lung diseases. Pulmonary Function Testing (PFT) is a crucial tool for identifying functional impairment, monitoring disease progression, and assessing treatment stages. The carbon monoxide diffusion test (DLCO) reflects the capacity for alveolar gas exchange. In sarcoidosis and other interstitial lung diseases, a decrease in DLCO can occur due to reduced alveolocapillary membrane surface area, which may result from parenchymal involvement and fibrosis. The 6-minute walk test (6MWT) is a reliable method frequently used to assess patients' functional capacity. Objective: The aim of this study is to investigate the relationship/correlation between the Thoracic CT Severity Score (TCSS), which has not yet been standardized for use in the follow-up of patients with sarcoidosis, and the parameters of Pulmonary Function Testing (PFT), DLCO, and the 6-minute walk test (6MWT). Additionally, the study aims to compare this with the Scadding staging system, which has been based on chest radiography and in use since 1961. Method: A retrospective analysis was conducted on 60 sarcoidosis patients (aged 18 and over) who were admitted to the Department of Pulmonary Diseases at Necmettin Erbakan University Medical Faculty Hospital between January 2015 and May 2024 for inpatient evaluation and follow-up of sarcoidosis. These patients were selected based on the availability of simultaneous (within a maximum of 3 months) chest X-rays, thoracic CT scans, Pulmonary Function Tests (PFT), DLCO measurements, and 6-minute walk tests (6MWT) in the hospital records. The records of the included patients were retrospectively reviewed. Demographic data (age, gender, comorbidities), thoracic CT severity scores, Scadding stages, PFT parameters including FVC, FVC%, FEV1, FEV1%, FEV1/FVC, PEF, FEF 25-75, FEF 25- 75%, DLCO and DLCO/VA in diffusion capacity measurements, and 6MWT parameters such as initial SPO2, final SPO2, desaturation percentage, walking distance, and the ratio of walked distance to expected distance (6MWT%) were recorded. Correlations between these parameters and both the TCSS and Scadding staging systems were separately analyzed, with the strengths and weaknesses of these two staging systems being investigated. Data were analyzed using the SPSS program. The results were evaluated at a 95% confidence interval, with significance set at p < 0.05. Findings: A moderate, statistically significant negative correlation was found between the Thoracic CT Severity Score (TCSS) and FEV1(%), FVC(%), DLCO, 6MWT final saturation, and 6MWT(%) results (r=-0.441; p<0.001, r=-0.477; p<0.001, r=-0.522; p<0.001, r=-0.417; p=0.001, and r=-0.511; p<0.001, respectively). A weak negative correlation was identified between TCSS and initial saturation (r=-0.296; p=0.022). A low to moderate positive correlation was observed between TCSS and desaturation, while a negative correlation was found between TCSS and 6MWT distance (r=0.370; p=0.004 and r=-0.341; p=0.008, respectively). No significant correlations were found between TCSS and FEV1, FVC, FEV1/FVC, PEF, FEF 25-75, FEF 25-75%, and DLCO/VA (r=-0.194; p=0.138, r=- 0.210; p=0.108, r=-0.156; p=0.233, r=-0.109; p=0.413, r=-0.019; p=0.886, r=-0.078; p=0.553, and r=-0.242; p=0.062, respectively). In the correlation analysis conducted according to Scadding stages, it was observed that as the stage increased, FEV1(%) and FVC(%) values decreased. A weak negative correlation with FEV1(%) and a low to moderate negative correlation with FVC(%) were found to be statistically significant (r=-0.29; p=0.010 and r=- 0.368; p=0.001, respectively). As the Scadding stages increased, DLCO and DLCO/VA values also decreased. A moderate negative correlation with DLCO and a low to moderate negative correlation with DLCO/VA were identified in relation to Scadding stages (r=-0.493; p<0.001 and r=-0.331; p=0.001, respectively). As the Scadding stages increased, initial oxygen saturation and final oxygen saturation values decreased, while desaturation values increased. A moderate negative correlation was found between Scadding stages and initial oxygen saturation, as well as final oxygen saturation, and a low to moderate positive correlation with desaturation values (r=-0.467; p=0.013, r=-0.501; p=0.016, and r=0.374; p=0.002, respectively). Additionally, as the Scadding stages increased, the 6MWT distance (m) and 6MWT distance (%) values decreased. A moderate negative correlation was found between the Scadding stages and both the 6MWT distance (m) and 6MWT distance (%) values (r=-0.470; p=0.003 and r=-0.462; p=0.034, respectively). When comparing Scadding staging with the Thoracic CT Severity Score (TCSS), it was determined that the correlations with FEV1(%), FVC(%), DLCO, and 6MWT(%) were higher for TCSS. On the other hand, FEV1, FVC, FEV1/FVC, DLCO/VA, initial SpO2, final SpO2, desaturation, and 6MWT distance values were found to have higher correlations with Scadding staging. Conclusion: Our study found that the Thoracic CT Severity Score (TCSS), which can radiologically grade the severity of pulmonary involvement in sarcoidosis, demonstrated significant correlations with nearly all functional parameters. Additionally, it revealed that TCSS showed stronger correlations with FEV1(%), FVC(%), DLCO, and 6MWT(%) data compared to the Scadding staging system. Therefore, TCSS should be considered in the follow-up of patients with sarcoidosis. This finding may pave the way for considering TCSS as an alternative to the Scadding staging system or for developing a new, combined staging system by modifying both approaches. To further explore this, larger-scale multicenter studies with broader case series similar to ours are needed.
Introduction: Sarcoidosis is a multisystemic disease characterized by the formation of granulomatous reactions/inflamattions in multiple organs, with an unkonwn etiology. Intrathoracic involvement, manifesting as symmetrical bilateral hilar lymphadenopathy and/or diffuse pulmonary micronodules, is observed in 90% of patients, predominantly affecting lymphatic structures, which are the most commonly involved system. Computed tomography (CT) is more sensitive than chest radiography for detecting lymphadenopathy and parenchymal abnormalities. Consequently, Thoracic CT has been extensively used in the diagnosis and follow-up of diffuse parenchymal lung diseases. Pulmonary Function Testing (PFT) is a crucial tool for identifying functional impairment, monitoring disease progression, and assessing treatment stages. The carbon monoxide diffusion test (DLCO) reflects the capacity for alveolar gas exchange. In sarcoidosis and other interstitial lung diseases, a decrease in DLCO can occur due to reduced alveolocapillary membrane surface area, which may result from parenchymal involvement and fibrosis. The 6-minute walk test (6MWT) is a reliable method frequently used to assess patients' functional capacity. Objective: The aim of this study is to investigate the relationship/correlation between the Thoracic CT Severity Score (TCSS), which has not yet been standardized for use in the follow-up of patients with sarcoidosis, and the parameters of Pulmonary Function Testing (PFT), DLCO, and the 6-minute walk test (6MWT). Additionally, the study aims to compare this with the Scadding staging system, which has been based on chest radiography and in use since 1961. Method: A retrospective analysis was conducted on 60 sarcoidosis patients (aged 18 and over) who were admitted to the Department of Pulmonary Diseases at Necmettin Erbakan University Medical Faculty Hospital between January 2015 and May 2024 for inpatient evaluation and follow-up of sarcoidosis. These patients were selected based on the availability of simultaneous (within a maximum of 3 months) chest X-rays, thoracic CT scans, Pulmonary Function Tests (PFT), DLCO measurements, and 6-minute walk tests (6MWT) in the hospital records. The records of the included patients were retrospectively reviewed. Demographic data (age, gender, comorbidities), thoracic CT severity scores, Scadding stages, PFT parameters including FVC, FVC%, FEV1, FEV1%, FEV1/FVC, PEF, FEF 25-75, FEF 25- 75%, DLCO and DLCO/VA in diffusion capacity measurements, and 6MWT parameters such as initial SPO2, final SPO2, desaturation percentage, walking distance, and the ratio of walked distance to expected distance (6MWT%) were recorded. Correlations between these parameters and both the TCSS and Scadding staging systems were separately analyzed, with the strengths and weaknesses of these two staging systems being investigated. Data were analyzed using the SPSS program. The results were evaluated at a 95% confidence interval, with significance set at p < 0.05. Findings: A moderate, statistically significant negative correlation was found between the Thoracic CT Severity Score (TCSS) and FEV1(%), FVC(%), DLCO, 6MWT final saturation, and 6MWT(%) results (r=-0.441; p<0.001, r=-0.477; p<0.001, r=-0.522; p<0.001, r=-0.417; p=0.001, and r=-0.511; p<0.001, respectively). A weak negative correlation was identified between TCSS and initial saturation (r=-0.296; p=0.022). A low to moderate positive correlation was observed between TCSS and desaturation, while a negative correlation was found between TCSS and 6MWT distance (r=0.370; p=0.004 and r=-0.341; p=0.008, respectively). No significant correlations were found between TCSS and FEV1, FVC, FEV1/FVC, PEF, FEF 25-75, FEF 25-75%, and DLCO/VA (r=-0.194; p=0.138, r=- 0.210; p=0.108, r=-0.156; p=0.233, r=-0.109; p=0.413, r=-0.019; p=0.886, r=-0.078; p=0.553, and r=-0.242; p=0.062, respectively). In the correlation analysis conducted according to Scadding stages, it was observed that as the stage increased, FEV1(%) and FVC(%) values decreased. A weak negative correlation with FEV1(%) and a low to moderate negative correlation with FVC(%) were found to be statistically significant (r=-0.29; p=0.010 and r=- 0.368; p=0.001, respectively). As the Scadding stages increased, DLCO and DLCO/VA values also decreased. A moderate negative correlation with DLCO and a low to moderate negative correlation with DLCO/VA were identified in relation to Scadding stages (r=-0.493; p<0.001 and r=-0.331; p=0.001, respectively). As the Scadding stages increased, initial oxygen saturation and final oxygen saturation values decreased, while desaturation values increased. A moderate negative correlation was found between Scadding stages and initial oxygen saturation, as well as final oxygen saturation, and a low to moderate positive correlation with desaturation values (r=-0.467; p=0.013, r=-0.501; p=0.016, and r=0.374; p=0.002, respectively). Additionally, as the Scadding stages increased, the 6MWT distance (m) and 6MWT distance (%) values decreased. A moderate negative correlation was found between the Scadding stages and both the 6MWT distance (m) and 6MWT distance (%) values (r=-0.470; p=0.003 and r=-0.462; p=0.034, respectively). When comparing Scadding staging with the Thoracic CT Severity Score (TCSS), it was determined that the correlations with FEV1(%), FVC(%), DLCO, and 6MWT(%) were higher for TCSS. On the other hand, FEV1, FVC, FEV1/FVC, DLCO/VA, initial SpO2, final SpO2, desaturation, and 6MWT distance values were found to have higher correlations with Scadding staging. Conclusion: Our study found that the Thoracic CT Severity Score (TCSS), which can radiologically grade the severity of pulmonary involvement in sarcoidosis, demonstrated significant correlations with nearly all functional parameters. Additionally, it revealed that TCSS showed stronger correlations with FEV1(%), FVC(%), DLCO, and 6MWT(%) data compared to the Scadding staging system. Therefore, TCSS should be considered in the follow-up of patients with sarcoidosis. This finding may pave the way for considering TCSS as an alternative to the Scadding staging system or for developing a new, combined staging system by modifying both approaches. To further explore this, larger-scale multicenter studies with broader case series similar to ours are needed.
Açıklama
Anahtar Kelimeler
Sarkoidoz, Sarcoidosis, toraks BT şiddet skoru, Thoracic CT Severity Score, SFT, PFT, DLCO, 6 dakika yürüme testi, 6 Minute Walk Test
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Takeş, M. A. (2024). Sarkoidozlu hastalarda toraks BT şiddet skorunun SFT,DLCO ve 6DYT ile ilişkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Göğüs Hastalıkları Anabilim Dalı, Konya.
