Nurşen DÜZGÜN, Çelebi Zeynep SÖZENER, Gülseren KARABIYIKOĞLU

Evaluation of the functional parameters in scleroderma cases with pulmonary involvement

Bu çalışmanın amacı skleroderma akciğer tutulumu olan hastalardaki fonksiyonel değişikliklerle tanısal testler arasındaki ilişkiyi irdelemek ve erken tanıda yardımcı olabilecek testleri saptamaktır. Bu prospektif çalışmaya 33 tane skleroderma akciğer tutulumu olan hasta dahil edildi. Solunum fonksiyon testleri yapılıp, ekokardiyografileri çekilen, arter kan gazları alınan hastalara altı dakika yürüme testi uygulandı. Yüksek rezolüsyonlu bilgisayarlı tomografileri çekilen hastalar; NYHA fonksiyonel sınıflandırması ve Borg dispne indeksine göre sınıflandırıldı. Hastalardan ayrıca SGRQ yaşam kalitesi anketini cevaplandırmaları istendi. Hastalarımızda en erken etkilenen fonksiyonel parametrenin %DLCO olduğu görüldü. %DLCO/%FVC oranının pulmoner arteryel hipertansiyonu noninvaziv olarak saptamadaki duyarlılığı düşük bulundu. SGRQ yaşam kalitesi anketinin ise tüm fonksiyonel parametreler ile korele olduğu saptandı. Skleroderma tanısı alan hastalar mutlaka pulmoner tutulum açısından değerlendirilmeli ve asemptomatik dahi olsalar bu açıdan takip edilmelidirler. Solunum fonksiyon testleri, ekokardiyografi, toraks yüksek rezolüsyonlu bilgisayarlı tomografi, altı dakika yürüme testi skleroderma akciğer tutulumunda tanı ve takipte kullanılan faydalı testlerdir. NYHA fonksiyonel sınıflandırması, Borg dispne indeksi ve MRC de erken tanıda yardımcıdır. SGRQ yaşam kalitesi anketi tanı ve takipte hastaların egzersiz kapasitesini belirlemede noninvaziv olarak kullanılabilecek faydalı bir testtir.

Skleroderma akciğer tutulumu olan hastalarda fonksiyonel parametrelerin değerlendirilmesi

To evaluate the relationship between functional changes in the scleroderma patients with pulmonary involvement and the diagnostic tests and to identify the tests that may be helpful in early diagnosis. In this prospective study, 33 scleroderma patients with pulmonary involvement were included. Pulmonary function tests, echocardiography, arterial blood gases, six minute walk tests, thorax high resolution computed tomography were performed and all patients were classified according to MRC dyspnea scores and NYHA(WHO) functional classification. Patients were also asked to conclude Saints Georges Respiratory Questionnaire (SGRQ). DLCO% found to be the earliest deteriorated parameter in our patients. Sensitivity of FVC%/DLCO% ratio, for detecting pulmonary arterial hypertension as a noninvasive method, was found low. SGRQ was found to be correlated with all functional parameters used in scleroderma follow up. Patients with scleroderma should be evaluated for pulmonary involvement and must be followed up ever if they were asymptomatic. Pulmonary function tests, echocardiography, thorax high resolution computed tomography, six minute walk tests are valuable tools that should be used in diagnosis and follow up. NYHA (WHO) functional classification, MRC and Borg dyspnea scores are also helpful for early diagnosis. SGRQ can also be helpful to evaluate the patients functional capacity in diagnosis and follow up as a non invasive parameter.

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