rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-591-599rsp-2623Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHЗначение компьютерной томографии высокого разрешения в оценке эффективности ритуксимаба у пациентов с интерстициальным поражением легких при системной склеродермииTHE IMPORTANCE OF HIGH-RESOLUTION COMPUTED TOMOGRAPHY IN EVALUATING THE EFFICACY OF RITUXIMAB IN PATIENTS WITH INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSISКоневаО. А.KonevaO. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

alloy75@yandex.ruДесиноваО. В.DesinovaO. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

АнаньеваЛ. П.AnanyevaL. P.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

КовалеваН. В.KovalevaN. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201808112018565591599Copyright © Конева О.А., Десинова О.В., Ананьева Л.П., Ковалева Н.В., 20182018Конева О.А., Десинова О.В., Ананьева Л.П., Ковалева Н.В.Koneva O.A., Desinova O.V., Ananyeva L.P., Kovaleva N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2623

Мультиспиральная компьютерная томография органов грудной клетки (МСКТ ОГК) является золотым стандартом для подтверждения интерстициальных изменений в легких, однако роль данного метода для оценки эффективности терапии при системной склеродермии (ССД) до конца не определена. Цель исследования – оценить динамику изменений легких по данным МСКТ ОГК и показателей функциональных легочных тестов (ФЛТ) у больных ССД с интерстициальным поражением легких (ИПЛ) на фоне активной терапии.Материал и методы. В исследование включено 42 пациента с достоверным диагнозом ССД, имевших признаки ИПЛ по данным МСКТ ОГК. Средний возраст пациентов составил 48±2 года; соотношение мужчин и женщин – 1:6, пациентов с диффузной и лимитированной формой болезни – 1,5:1 (25 и 17); средняя длительность ССД составляла 6,6±5,9 года. У всех пациентов на момент включения в исследование и в среднем через 29±15,3 мес (от 9 до 70 мес) в динамике на фоне терапии исследовались форсированная жизненная емкость легких (ФЖЕЛ), диффузионная способность легких (ДСЛ) и выполнялась МСКТ ОГК. Клинически значимым считалось изменение показателей ФЛТ на 10% и более. За период наблюдения пациенты получали терапию ритуксимабом (РТМ) в средней суммарной дозе 2,5±1,3 г (от 500 мг до 5 г) в сочетании с глюкокортикоидами в средней дозе 11,7±3,9 мг в пересчете на преднизолон; 10 (24%) пациентов также получали иммуносупрессанты.Анализ МСКТ ОГК проводился на 5 уровнях. На каждом уровне по 4-балльной системе (0–3 балла) оценивались выраженность изменений по типу «матового стекла», «медовых сот», ретикулярных изменений. Отдельно оценивалась динамика этих параметров и показателей ФЛТ у пациентов с поражением до 20% (группа А; 31%, n=13) и больше 20% (группа В, 69%, n=29) легочной ткани.Результаты и обсуждение. Полуколичественная оценка изменений по данным МСКТ ОГК у больных ССД с ИПЛ не выявила какой-либо динамики их общего счета. По субъективной оценке рентгенолога, положительная динамика при МСКТ отмечена у 8 (19%), отрицательная – у 11 (26%), не было динамики у 23 (55%) пациентов. Нарастание ФЖЕЛ на 10% и более выявлено у 16 (38%), снижение – у 3 (7%) пациентов. Положительная динамика ДСЛ выявлена у 5 (12%) пациентов, отрицательная – у 1 (2,4%). В среднем по группе наблюдались достоверное нарастание ФЖЕЛ с 73,2±18,8 до 82±21,8% (р=0,000031) и стабилизация ДСЛ. Ни у одного из пациентов с положительной МСКТ-динамикой не отмечено ухудшения ФЖЕЛ. На фоне терапии в группе А положительная динамика при МСКТ выявлена в 5 (38%), а в группе В – в 3 (10%) случаях (р=0,08), отрицательная динамика в группе А не отмечена ни в одном случае, в группе В – наблюдалась у 11(38%) пациентов. ФЖЕЛ клинически значимо увеличилась в группе А у 6 (46%) пациентов, в группе В – у 10 (34%), снизилась – у 1 (8%) и 2 (7%) соответственно. ФЖЕЛ была достоверно выше в группе А по сравнению с группой В как на момент включения в исследование (88,8±18,6 и 65,4±14,5%, р=0,0002), так и в отдаленном периоде (103,3±15,9 и 74,1±18,5%, р=0,0009), при этом на фоне терапии она статистически значимо увеличилась в обеих группах (р=0,016 и р=0,0014 соответственно). Медиана прироста ФЖЕЛ в группе А составила 10,2 [4,7; 21,9] %, в группе В – 5,9 [2,75; 14,7] % (р>0,05). Средний счет «матового стекла» в группе А по сравнению с группой В был достоверно ниже как на момент включения в исследование (2,9±2,3 и 6,6±2,7; р=0,01), так и в отдаленном периоде (1,6±1,4 и 6,4±3,0 соответственно, р=0,000006) и имел тенденцию к уменьшению на фоне терапии. Аналогичная закономерность наблюдалась и при оценке ретикулярных изменений (4,3 ±2,7 и 8,7±3,2, р=0,001; 3,1±2,5 и 8,8±2,0 соответственно, р=0,00000). У больных группы В достоверно увеличился счет «медовых сот» (p=0,047).Заключение. Полуколичественная оценка структурных изменений по данным МСКТ ОГК у больных ССД с ИПЛ не выявила какой-либо динамики их общего счета за достаточно продолжительный период наблюдения. В то же время в группе больных с распространенностью ИПЛ <20% достоверно снижался счет «матового стекла», а у больных при поражении >20% легочной ткани достоверно нарастал счет «медовых сот». В целом по группе на фоне активной терапии происходило нарастание ФЖЕЛ и стабилизация ДСЛ, а медиана их прироста была выше при распространенности ИПЛ <20%. Эти данные позволяют рассматривать исходную площадь легочного поражения в качестве потенциального предиктора ответа на терапию у больных ССД с ИПЛ.

Multi-slice spiral computed tomography (MSCT) of the chest is the gold standard for confirming interstitial changes in the lung; but the role of this technique in evaluating the efficiency of therapy for systemic sclerosis (SSc) has not been fully defined.Objective: to assess the time course of changes in the lung according to chest MSCT findings and pulmonary function test (PFT) results in SSc patients and interstitial lung disease (ILD) during of active treatment.Subjects and methods. The investigation enrolled 42 patients with a reliable diagnosis of SSc who had signs of ILD, confirmed by chest MSCT. The patients’ mean age was 48±2 years; the male-to-female ratio was 1:6; that of diffuse-to-localized SSc patients was 1.5:1 (25 and 17); the mean duration of SSc was 6.6±5.9 years. Over time during therapy, forced lung capacity (FVC) and lung diffusing capacity (LDC) were studied and chest MSCT was performed in all the patients at the time of inclusion in the study and after an average of 29±15.3 months (9 to 70 months). A 10% or more change in PFT results was considered to be of clinical significance. During the follow-up period, the patients were treated with rituximab (RTM) at a mean total dose of 2.5±1.3 g (500 mg to 5 g) in combination with glucocorticoids at a mean dose of 11.7±3.9 mg calculated with reference to prednisolone; 10 (24%) patients also received immunosuppressants.Chest MSCT data were analyzed at 5 levels. The magnitude of changes following the pattern seen in frosted glass, honeycomb, and reticular alterations was estimated using a 4-point (0–3 points) scale at each level. The time course of changes in these parameters and PFT results was separately assessed in patients with less and more than 20% of lung tissue injury in Group A (n=13 (31%) and in Group B (n=29 (69%).Results and discussion. Semiquantitative assessment of changes as evidenced by chest MSCT in SSc patients with ILD did not reveal any changes in their total scores. According to a radiologist’s subjective assessment, there were positive and negative MSCT changes in 8 (19%) and 11 (26%) patients, respectively; the changes were present in 23 (55%) patients. A 10% and more increase in FVC was observed in 16 (38%) patients; its decrease was seen in 3 (7%). Positive and negative LDC changes were found in 5 (12%) and 1 (2.4%) patients, respectively. On average, the group showed a significant FVC increase from 73.2±18.8 to 82±21.8% (p=0.000031) and LDC stabilization. None of the patients with positive MSCT changes exhibited FVC deterioration. During therapy, Groups A and B had positive MSCT changes in 5 (38%) and 3 (10%) cases, respectively (p=0.08); no negative changes were noted in Group A while Group B had negative changes in 11 (38%) cases. FVC increased clinically significantly in 6 (46%) patients in Group A and in 10 (34%) in Group B; this decreased in 1 (8%) and 2 (7%) patients, respectively. FVC was significantly higher in Group A than that in Group B both at the time of study inclusion (88.8±18.6 and 65.4±14.5%, respectively; p=0.0002) and in the long-term period (103.3±15.9 and 74.1±18.5%; p=0.0009), while during therapy this increased statistically significantly in both groups (p=0.016 and p=0.0014, respectively). In Groups A and B, the median FVC increments were 10.2 (4.7; 21.9)% and 5.9 (2.75; 14.7)% , respectively (p>0.05). The mean frosted glass score was significantly lower in Group A than that in Group B both at the time of study inclusion (2.9±2.3 and 6.6±2.7; p=0.01) and in the long-term period (1.6±1.4 and 6.4±3.0, respectively; p=0.000006) and this tended to decrease during therapy. A similar pattern was observed with reticular alterations(4.3±2.7 and 8.7±3.2 (p=0.001) and 3.1±2.5 and 8.8±2.0 (p<0.00001), respectively). In Group B, honeycomb scores significantly increased (p=0.047).Conclusion. Semiquantitative assessment of structural changes by chest MSCT in SSc patients and ILD did not reveal any changes in their total scores for a sufficiently long follow-up period. At the same time, the frosted glass scores significantly decreased in patients with an ILD area of <20%, and the honeycomb scores significantly increased in those with >20% of lung tissue injury. During active therapy, the entire group displayed an increase in FVC, as well as LDC stabilization, and their median increments were higher in the patients with an ILD area of <20%. These findings allow the baseline pulmonary injury area to be considered as a potential predictor for a response to therapy in SSc patients with ILD.

системная склеродермияинтерстициальное поражение легкихмультиспиральная компью- терная томографияфункциональные легочные тестыsystemic sclerosisinterstitial lung diseasemulti-slice spiral computed tomographypulmonary function testsReferencesVarga J, Abraham D. Systemic sclerosis: prototypic multisystem fibrotic disorder. J Clin Invest. 2007;117(3):557-67. doi: 10.1172/JCI31139Varga J, Abraham D. Systemic sclerosis: prototypic multisystem fibrotic disorder. J Clin Invest. 2007;117(3):557-67. doi: 10.1172/JCI31139Wells AU. Interstitial lung disease in systemic sclerosis. Presse Мed. 2014;43:329-43. doi: 10.1016/j.lpm.2014.08.002Wells AU. Interstitial lung disease in systemic sclerosis. Presse Мed. 2014;43:329-43. doi: 10.1016/j.lpm.2014.08.002Capelli S, Bellando Randone S, Camiciottoli G, et al. Interstitial lung disease in systemic sclerosis: where do we stand? Eur Respir Rev. 2015;24(137):411-9. doi: 10.1183/16000617.00002915Capelli S, Bellando Randone S, Camiciottoli G, et al. Interstitial lung disease in systemic sclerosis: where do we stand? Eur Respir Rev. 2015;24(137):411-9. doi: 10.1183/16000617.00002915Steen VD, Medsger TA. Changes in causes of death in systemic sclerosis. 1972–2002. Ann Rheum Dis. 2007;66:940-4. doi: 10.1136/ard.2006.066068Steen VD, Medsger TA. Changes in causes of death in systemic sclerosis. 1972–2002. Ann Rheum Dis. 2007;66:940-4. doi: 10.1136/ard.2006.066068Tyndall AJ, Bannert B, Vonk M, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010;69(10):1809-15. doi: 10.1136/ard.2009.114264Tyndall AJ, Bannert B, Vonk M, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010;69(10):1809-15. doi: 10.1136/ard.2009.114264Plastiras SC, Karadimitrakis SP, Ziakas PD, et al. Scleroderma lung: initial forced vital capacity as predictor of pulmonary function decline. Arthritis Rheum. 2006;55(4):598-602.Plastiras SC, Karadimitrakis SP, Ziakas PD, et al. Scleroderma lung: initial forced vital capacity as predictor of pulmonary function decline. Arthritis Rheum. 2006;55(4):598-602.Fransen J, Popa-Diaconu D, Hesselstrand R, et al. Clinical prediction of 5-year survival in systemic sclerosis: validation of a simple prognostic model in EUSTAR centres. Ann Rheum Dis. 2011;70(10):1788-92. doi: 10.1136/ard.2010.144360Fransen J, Popa-Diaconu D, Hesselstrand R, et al. Clinical prediction of 5-year survival in systemic sclerosis: validation of a simple prognostic model in EUSTAR centres. Ann Rheum Dis. 2011;70(10):1788-92. doi: 10.1136/ard.2010.144360Khanna D, Clements PJ, Furst DE, et al. Correlation of the degree of dyspnea with health-related quality of life, functional abilities, and diffusing capacity for carbon monoxide in patients with systemic sclerosis and active alveolitis: Results from the scleroderma lung study. Arthritis Rheum. 2005;52(2):592-600. doi: 10.1002/art.20787Khanna D, Clements PJ, Furst DE, et al. Correlation of the degree of dyspnea with health-related quality of life, functional abilities, and diffusing capacity for carbon monoxide in patients with systemic sclerosis and active alveolitis: Results from the scleroderma lung study. Arthritis Rheum. 2005;52(2):592-600. doi: 10.1002/art.20787Simeon CP, Armadans L, Fonollosa V, et al. Mortality and prognostic factors in Spanish patients with systemic sclerosis. Rheumatology (Oxford). 2003;42(1):71-5. doi: 10.1093/rheumatology/keg033Simeon CP, Armadans L, Fonollosa V, et al. Mortality and prognostic factors in Spanish patients with systemic sclerosis. Rheumatology (Oxford). 2003;42(1):71-5. doi: 10.1093/rheumatology/keg033Wells AU, Hansell DM, Rubens MB, et al. The predictive value of appearances on thin-section computed tomography in fibrosing alveolitis. Am Rev Respir Dis. 1993;148:1076-82. doi: 10.1164/ajrccm/148.4_Pt_1.1076Wells AU, Hansell DM, Rubens MB, et al. The predictive value of appearances on thin-section computed tomography in fibrosing alveolitis. Am Rev Respir Dis. 1993;148:1076-82. doi: 10.1164/ajrccm/148.4_Pt_1.1076Wells AU, Hansell DM, Corrin B, et al. High resolution computed tomography as a predictor of lung histology in systemic sclerosis. Thorax. 1992;47:738-42. doi: 10.1136/thx.47.9.738Wells AU, Hansell DM, Corrin B, et al. High resolution computed tomography as a predictor of lung histology in systemic sclerosis. Thorax. 1992;47:738-42. doi: 10.1136/thx.47.9.738Pignone A, Matucci-Cerinic M, Lombardi A, et al. High resolution computed tomography in systemic sclerosis. Real diagnostic utilities in the assessment of pulmonary involvement and comparison with other modalilities of lung investigation. Clin Rheumatol. 1992;11:465-72. doi: 10.1007/BF02283100Pignone A, Matucci-Cerinic M, Lombardi A, et al. High resolution computed tomography in systemic sclerosis. Real diagnostic utilities in the assessment of pulmonary involvement and comparison with other modalilities of lung investigation. Clin Rheumatol. 1992;11:465-72. doi: 10.1007/BF02283100Sergiacomi G, De Nardo D, Carpia A, et al. Non-invasive diagnostic and functional evaluation of cardiac and pulmonary involvement in systemic sclerosis. In Vivo. 2004;18:229-35.Sergiacomi G, De Nardo D, Carpia A, et al. Non-invasive diagnostic and functional evaluation of cardiac and pulmonary involvement in systemic sclerosis. In Vivo. 2004;18:229-35.Chan TY, Hansell DM, Rubens MB, et al. Cryptogenic fibrosing alveolitis and the fibrosing alveolitis of systemic sclerosis: morphological differences on computed tomographic scans. Thorax. 1997;52:265-70. doi: 10.1136/thx.52.3.265Chan TY, Hansell DM, Rubens MB, et al. Cryptogenic fibrosing alveolitis and the fibrosing alveolitis of systemic sclerosis: morphological differences on computed tomographic scans. Thorax. 1997;52:265-70. doi: 10.1136/thx.52.3.265Wells AU, Steen V, Valentini G. Pulmonary complications: one of the most challenging complications of systemic sclerosis. Rheumatology (Oxford). 2009;48:40-4. doi: 10.1093/rheumatology/kep109Wells AU, Steen V, Valentini G. Pulmonary complications: one of the most challenging complications of systemic sclerosis. Rheumatology (Oxford). 2009;48:40-4. doi: 10.1093/rheumatology/kep109Desai SR, Veeraraghavan S, Hansell DM, et al. CT features of lung disease in patients with systemic sclerosis: comparison with idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Radiology. 2004;232:560-7. doi: 10.1148/radiol.2322031223Desai SR, Veeraraghavan S, Hansell DM, et al. CT features of lung disease in patients with systemic sclerosis: comparison with idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Radiology. 2004;232:560-7. doi: 10.1148/radiol.2322031223Launay D, Remy-Jardin M, Michon-Pasturel U, et al. High resolution computed tomography in fibrosing alveolitis associated with systemic sclerosis. J Rheumatol. 2006;33:1789-801.Launay D, Remy-Jardin M, Michon-Pasturel U, et al. High resolution computed tomography in fibrosing alveolitis associated with systemic sclerosis. J Rheumatol. 2006;33:1789-801.Assayag D, Kadury S, Hudson M, et al. High resolution computed tomography scoring systems for evaluating interstitial lung disease in systemic sclerosis patients. Rheumatology. 2012;S1:003. doi: 10.4172/2161-1149. S1-003Assayag D, Kadury S, Hudson M, et al. High resolution computed tomography scoring systems for evaluating interstitial lung disease in systemic sclerosis patients. Rheumatology. 2012;S1:003. doi: 10.4172/2161-1149. S1-003Walsh SLF, Sverzellati N, Devaraj A, et al. Connective tissue disease related fibrotic lung disease: high resolution computed tomographic and pulmonary function indices as prognostic determinants. Thorax. 2014;69(3):216-22. doi: 10.1136/thoraxjnl-2013-203843Walsh SLF, Sverzellati N, Devaraj A, et al. Connective tissue disease related fibrotic lung disease: high resolution computed tomographic and pulmonary function indices as prognostic determinants. Thorax. 2014;69(3):216-22. doi: 10.1136/thoraxjnl-2013-203843Watadani T, Sakai F, Johkoh T, et al. Interobserver variability in the CT assessment of honeycombing in the lungs. Radiology. 2013;266(3):936-44. doi: 10.1148/radiol.12112516Watadani T, Sakai F, Johkoh T, et al. Interobserver variability in the CT assessment of honeycombing in the lungs. Radiology. 2013;266(3):936-44. doi: 10.1148/radiol.12112516Sundaram B, Gross BH, Martinez FJ, et al. Accuracy of high-resolution CT in the diagnosis of diff use lung disease: effect of predominance and distribution of findings. AJR Am J Roentgenol. 2008;191(4):1032-9. doi: 10.2214/AJR.07.3177Sundaram B, Gross BH, Martinez FJ, et al. Accuracy of high-resolution CT in the diagnosis of diff use lung disease: effect of predominance and distribution of findings. AJR Am J Roentgenol. 2008;191(4):1032-9. doi: 10.2214/AJR.07.3177Daoussis D, Liossis SN, Tsamandas AC, et al. Experience with rituximab in scleroderma: results from a 1-year, proof-of-principle study. Rheumatology. 2010;49:271-80. doi: 10.1093/rheumatology/kep093Daoussis D, Liossis SN, Tsamandas AC, et al. Experience with rituximab in scleroderma: results from a 1-year, proof-of-principle study. Rheumatology. 2010;49:271-80. doi: 10.1093/rheumatology/kep093Tashkin DP, Elashoff R, Clements PG, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med. 2006;354:2655-66. doi: 10.1056/NEJMoa055120Tashkin DP, Elashoff R, Clements PG, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med. 2006;354:2655-66. doi: 10.1056/NEJMoa055120Wells AU, Desai SR, Rubens MB, et al. Idiopathic pulmonary fibrosis: a composite physiologic index derived from disease extent observed by computed tomography. Am J Respir Crit Care Med. 2003;167(7):962-9. doi: 10.1164/rccm.2111053Wells AU, Desai SR, Rubens MB, et al. Idiopathic pulmonary fibrosis: a composite physiologic index derived from disease extent observed by computed tomography. Am J Respir Crit Care Med. 2003;167(7):962-9. doi: 10.1164/rccm.2111053Kazerooni EA, Martinez FJ, Flint A, et al. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring. AJR Am J Roentgenol. 1997;169(4):977-83. doi: 10.2214/ajr.169.4.9308447Kazerooni EA, Martinez FJ, Flint A, et al. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring. AJR Am J Roentgenol. 1997;169(4):977-83. doi: 10.2214/ajr.169.4.9308447Warrick JH, Bhalla M, Schabel SI, Silver RM. High resolution computed tomography in early scleroderma lung disease. J Rheumatol. 1991;18(10):1520-8.Warrick JH, Bhalla M, Schabel SI, Silver RM. High resolution computed tomography in early scleroderma lung disease. J Rheumatol. 1991;18(10):1520-8.Steen VD, Conte C, Owens GR, Medsgar T. Severe restrictive lung disease in systemic sclerosis. Arthritis Rheum. 1994;37:1283-9. doi: 10.1002/art.1780370903Steen VD, Conte C, Owens GR, Medsgar T. Severe restrictive lung disease in systemic sclerosis. Arthritis Rheum. 1994;37:1283-9. doi: 10.1002/art.1780370903Zompatori M, Leone MB, Giannotta M, et al. Pulmonary hypertension and systemic sclerosis: the role of high-resolution computed tomography. Radiol Med. 2013;118:1360-72. doi: 10.1007/s11547-013-0934-1Zompatori M, Leone MB, Giannotta M, et al. Pulmonary hypertension and systemic sclerosis: the role of high-resolution computed tomography. Radiol Med. 2013;118:1360-72. doi: 10.1007/s11547-013-0934-1Лесняк ВН, Ананьева ЛП, Конева ОА и др. Полуколичественные визуальные методы оценки выраженности интерстициальных поражений легких по данным компьютерной томографии при системной склеродермии. Пульмонология. 2017;27(1):41-50 [Lesnyak VN, Anan'eva LP, Koneva OA, et al. Semi-quantification image methods for assessing severity of scleroderma-associated interstitial lungЛесняк ВН, Ананьева ЛП, Конева ОА и др. Полуколичественные визуальные методы оценки выраженности интерстициальных поражений легких по данным компьютерной томографии при системной склеродермии. Пульмонология. 2017;27(1):41-50 [Lesnyak VN, Anan'eva LP, Koneva OA, et al. Semi-quantification image methods for assessing severity of scleroderma-associated interstitial lungdisease according to computed tomography data. Pul’monologiya = Russian Pulmonology. 2017;27(1):41-50 (In Russ.)]. doi: 10.18093/0869_0189_2017_27_1_41_50.disease according to computed tomography data. Pul’monologiya = Russian Pulmonology. 2017;27(1):41-50 (In Russ.)]. doi: 10.18093/0869_0189_2017_27_1_41_50.Goh NS, Desai SR, Veeraraghavan S, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 2008;177(11):1248-54. doi: 10.1164/rccm.200706-877OCGoh NS, Desai SR, Veeraraghavan S, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 2008;177(11):1248-54. doi: 10.1164/rccm.200706-877OCMoore O, Goh N, Corte T, et al. Extent of disease on high- resolution computed tomography lung is a predictor of decline and mortality in systemic sclerosis – related interstitial lung disease. Rheumatology. 2013;52:155-60. doi: 10.1093/rheumatology/kes289Moore O, Goh N, Corte T, et al. Extent of disease on high- resolution computed tomography lung is a predictor of decline and mortality in systemic sclerosis – related interstitial lung disease. Rheumatology. 2013;52:155-60. doi: 10.1093/rheumatology/kes289Van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-47. doi: 10.1002/art.38098Van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-47. doi: 10.1002/art.38098Fischer A, Swigris JJ, Bolster MB, et al. Pulmonary hypertension and interstitial lung disease within PHAROS: impact of extent of fibrosis and pulmonary physiology on cardiac haemodynamic parameters. Clin Exp Rheumatol 2014;32 Suppl. 86:109-14.Fischer A, Swigris JJ, Bolster MB, et al. Pulmonary hypertension and interstitial lung disease within PHAROS: impact of extent of fibrosis and pulmonary physiology on cardiac haemodynamic parameters. Clin Exp Rheumatol 2014;32 Suppl. 86:109-14.Wells AU, Hansell DM, Rubens MB, et al. Fibrosing alveolitis in systemic sclerosis: indices of lung function in relations to extent of disease on computed tomography. Arthritis Rheum. 1997;40:1229-36.Wells AU, Hansell DM, Rubens MB, et al. Fibrosing alveolitis in systemic sclerosis: indices of lung function in relations to extent of disease on computed tomography. Arthritis Rheum. 1997;40:1229-36.Davas EM, Peppas C, Maragou M, et al. Intravenous cyclophosphamide pulse therapy for the treatment of lung disease associated with scleroderma. Clin Rheumatol. 1999;18(6):455-61. doi: 10.1007/s100670050138Davas EM, Peppas C, Maragou M, et al. Intravenous cyclophosphamide pulse therapy for the treatment of lung disease associated with scleroderma. Clin Rheumatol. 1999;18(6):455-61. doi: 10.1007/s100670050138White B, Moore WC, Wigley FM, et al. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma and alveolitis. Ann Intern Med. 2000;132(12):947-54. doi: 10.7326/0003-4819-132-12-200006200-00004White B, Moore WC, Wigley FM, et al. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma and alveolitis. Ann Intern Med. 2000;132(12):947-54. doi: 10.7326/0003-4819-132-12-200006200-00004Vallentini G, Della Rossa A, Bombardier S, et al. European multicentre study of define disease activity variables and development of preliminary activity indexes. Ann Rheum Dis. 2001;60:592-8. doi: 10.1136/ard.60.6.592Vallentini G, Della Rossa A, Bombardier S, et al. European multicentre study of define disease activity variables and development of preliminary activity indexes. Ann Rheum Dis. 2001;60:592-8. doi: 10.1136/ard.60.6.592Nichtyanova SI, Tang EC, Coghlan JG, et al. Improved survival in systemic sclerosis is associated with better ascertainment of internal organ disease: a retrospective cohort study. QJM. 2010;103:109-15. doi: 10.1093/qjmed/hcp174Nichtyanova SI, Tang EC, Coghlan JG, et al. Improved survival in systemic sclerosis is associated with better ascertainment of internal organ disease: a retrospective cohort study. QJM. 2010;103:109-15. doi: 10.1093/qjmed/hcp174Van Laar JM, Farge D, Sont JK, et al. High dose immunoablation and autolougous hematopoetic stem cell transplantation versus monthly intravenous pulse therapy cyclophosphamide in severe systemic sclerosis [abstract]. Arthritis Rheum. 2012;64:4167.Van Laar JM, Farge D, Sont JK, et al. High dose immunoablation and autolougous hematopoetic stem cell transplantation versus monthly intravenous pulse therapy cyclophosphamide in severe systemic sclerosis [abstract]. Arthritis Rheum. 2012;64:4167.Ariani A, Silva M, Seletti V, et al. Quantitative chest computed tomography is associated with two prediction models of mortality in interstitial lung disease related to systemic sclerosis. Rheumatology. 2017;56:922-7. doi: 10.1093/rheumatology/kew480Ariani A, Silva M, Seletti V, et al. Quantitative chest computed tomography is associated with two prediction models of mortality in interstitial lung disease related to systemic sclerosis. Rheumatology. 2017;56:922-7. doi: 10.1093/rheumatology/kew480Harrison NK, Myers AR, Corrin B, et al. Structural features of interstitial lung disease in systemic sclerosis. Am Rev Respir Dis. 1991;144(3 Pt 1):706-13. doi: 10.1164/ajrccm/144.3_Pt_1.706Harrison NK, Myers AR, Corrin B, et al. Structural features of interstitial lung disease in systemic sclerosis. Am Rev Respir Dis. 1991;144(3 Pt 1):706-13. doi: 10.1164/ajrccm/144.3_Pt_1.706Lopes AJ, Capone D, Mogami R. Systemic sclerosis-associated interstitial pneumonia: evaluation of pulmonary function over fiveyear period. J Bras Pneumol. 2011 Mar-Apr;37(2):144-51. doi: 10.1590/S1806-37132011000200003Lopes AJ, Capone D, Mogami R. Systemic sclerosis-associated interstitial pneumonia: evaluation of pulmonary function over fiveyear period. J Bras Pneumol. 2011 Mar-Apr;37(2):144-51. doi: 10.1590/S1806-37132011000200003De Santis M, Bosello SL, Peluso G, et al. Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease. Clin Respir J. 2012 Jan;6(1):9-17. doi: 10.1111/j.1752-699X.2010.00228.xDe Santis M, Bosello SL, Peluso G, et al. Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease. Clin Respir J. 2012 Jan;6(1):9-17. doi: 10.1111/j.1752-699X.2010.00228.xWinstone TA, Assayag D, Wilcox PG, et al. Predictors of mortality and progression in scleroderma-associated interstitial lung disease. Systematic review. Chest. 2014;146(2):422-36. doi: 10.1378/chest.13-2626Winstone TA, Assayag D, Wilcox PG, et al. Predictors of mortality and progression in scleroderma-associated interstitial lung disease. Systematic review. Chest. 2014;146(2):422-36. doi: 10.1378/chest.13-2626Khanna D, Brown KK, Klements PJ, et al. Systemic sclerosisassociated interstitial lung diseases – proposed recommendations for future randomized clinical trails. Clin Exp Rheumatol. 2010;28(2 Suppl 58):55-62.Khanna D, Brown KK, Klements PJ, et al. Systemic sclerosisassociated interstitial lung diseases – proposed recommendations for future randomized clinical trails. Clin Exp Rheumatol. 2010;28(2 Suppl 58):55-62.Khanna D, Tseng CH, Farmani N, et al. Clinical course of lung physiology in patients with scleroderma and interstitial lung disease: analysis of the Scleroderma Lung Study Placebo Group. Arthritis Rheum. 2011 Oct;63(10):3078-85. doi: 10.1002/art.30467Khanna D, Tseng CH, Farmani N, et al. Clinical course of lung physiology in patients with scleroderma and interstitial lung disease: analysis of the Scleroderma Lung Study Placebo Group. Arthritis Rheum. 2011 Oct;63(10):3078-85. doi: 10.1002/art.30467Diot E, Giraudeau B, Diot P, et al. Is anti-topoisomerase I a serum marker of pulmonary involvement in systemic sclerosis? Chest. 1999 Sep;116(3):715-20. doi: 10.1378/chest.116.3.715Diot E, Giraudeau B, Diot P, et al. Is anti-topoisomerase I a serum marker of pulmonary involvement in systemic sclerosis? Chest. 1999 Sep;116(3):715-20. doi: 10.1378/chest.116.3.715Liu X, Mayes MD, Pedroza C, et al. Does C-reactive protein predict the long-term progression of interstitial lung disease and survival in patients with early systemic sclerosis? Arthritis Care Res (Hoboken). 2013 Aug;65(8):1375-80. doi: 10.1002/acr.21968Liu X, Mayes MD, Pedroza C, et al. Does C-reactive protein predict the long-term progression of interstitial lung disease and survival in patients with early systemic sclerosis? Arthritis Care Res (Hoboken). 2013 Aug;65(8):1375-80. doi: 10.1002/acr.21968McQueen FM, Solanki K. Rituximab in diffuse cutaneous systemic sclerosis: should we be using it today? Rheumatology (Oxford). 2015;54(5):757-67. doi: 10.1093/rheumatology/keu463McQueen FM, Solanki K. Rituximab in diffuse cutaneous systemic sclerosis: should we be using it today? Rheumatology (Oxford). 2015;54(5):757-67. doi: 10.1093/rheumatology/keu463Daoussis D, Liossis SN, Tsamandas AC, et al. Effect of long-term treatment with rituximab on pulmonary function and skin fibrosis in patients with diffuse systemic sclerosis. Clin Exp Rheumatol. 2012;30(2 Suppl 71):17-22.Daoussis D, Liossis SN, Tsamandas AC, et al. Effect of long-term treatment with rituximab on pulmonary function and skin fibrosis in patients with diffuse systemic sclerosis. Clin Exp Rheumatol. 2012;30(2 Suppl 71):17-22.Bosello S, De Santis M, Lama G, et al. B cell depletion in diffuse progressive systemic sclerosis: safety, skin score modification and IL-6 modulation in an up to thirty-six months follow-up openlabel trial. Arthritis Res Ther. 2010;12(2):54. doi: 10.1186/ar2965Bosello S, De Santis M, Lama G, et al. B cell depletion in diffuse progressive systemic sclerosis: safety, skin score modification and IL-6 modulation in an up to thirty-six months follow-up openlabel trial. Arthritis Res Ther. 2010;12(2):54. doi: 10.1186/ar2965Smith V, van Praet JT, Vandooren B, et al. Rituximab in diffuse cutaneous systemic sclerosis: an open-label clinical and histopathological study. Ann Rheum Dis. 2010;69(1):193-7. doi: 10.1136/ard.2008.095463Smith V, van Praet JT, Vandooren B, et al. Rituximab in diffuse cutaneous systemic sclerosis: an open-label clinical and histopathological study. Ann Rheum Dis. 2010;69(1):193-7. doi: 10.1136/ard.2008.095463Smith V, Piette Y, van Praet JT, et al. Two-year results of an open pilot study of a 2-treatment course with rituximab in patients with early systemic sclerosis with diffuse skin involvement. J Rheumatol. 2013;40(1):52-7. doi: 10.3899/jrheum.120778Smith V, Piette Y, van Praet JT, et al. Two-year results of an open pilot study of a 2-treatment course with rituximab in patients with early systemic sclerosis with diffuse skin involvement. J Rheumatol. 2013;40(1):52-7. doi: 10.3899/jrheum.120778Jordan S, Distler JH, Maurer B, et al. Effects and safety of rituximab in systemic sclerosis: an analysis from the European Scleroderma Trial and Research (EUSTAR) group. Ann Rheum Dis. 2015;74(6):1188-94. doi: 10.1136/annrheumdis-2013-204522Jordan S, Distler JH, Maurer B, et al. Effects and safety of rituximab in systemic sclerosis: an analysis from the European Scleroderma Trial and Research (EUSTAR) group. Ann Rheum Dis. 2015;74(6):1188-94. doi: 10.1136/annrheumdis-2013-204522Keir GJ, Maher TM, Ming D, et al. Rituximab in severe, treatment-refractory interstitial lung disease. Respirology. 2014;19(3):353-9. doi: 10.1111/resp.12214Keir GJ, Maher TM, Ming D, et al. Rituximab in severe, treatment-refractory interstitial lung disease. Respirology. 2014;19(3):353-9. doi: 10.1111/resp.12214Ананьева ЛП, Десинова ОВ, Конева ОА и др. Лечение ритуксимабом интерстициального поражения легких при системной склеродермии. Научно-практическая ревматология. 2013;51(5):514-23 [Ananyeva LP, Desinova OV, Koneva OA, et al. Rituximab treatment for interstitial lung injury in scleroderma systematica. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2013;51(5):514-23 (In Russ.)]. doi: 10.14412/1995-4484-2013-1542.Ананьева ЛП, Десинова ОВ, Конева ОА и др. Лечение ритуксимабом интерстициального поражения легких при системной склеродермии. Научно-практическая ревматология. 2013;51(5):514-23 [Ananyeva LP, Desinova OV, Koneva OA, et al. Rituximab treatment for interstitial lung injury in scleroderma systematica. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2013;51(5):514-23 (In Russ.)]. doi: 10.14412/1995-4484-2013-1542.Schurawitzki H, Stiglbauer R, Graninger W, et al. Interstitial lung disease in progressive systemic sclerosis: high-resolution CT versus radiography. Radiology. 1990;176:755-9. doi: 10.1148/radiology. 176.3.2389033Schurawitzki H, Stiglbauer R, Graninger W, et al. Interstitial lung disease in progressive systemic sclerosis: high-resolution CT versus radiography. Radiology. 1990;176:755-9. doi: 10.1148/radiology. 176.3.2389033Remy-Jardin M, Remy J, Wallaert B, et al. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology. 1993;188:499-506. doi: 10.1148/radiology. 188.2.8327704Remy-Jardin M, Remy J, Wallaert B, et al. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology. 1993;188:499-506. doi: 10.1148/radiology. 188.2.8327704Goldin JG, Lynch DA, Strollo DC, et al. High-resolution CT scan findings in patients with symptomatic scleroderma-related interstitial lung disease. Chest. 2007;134:358-67. doi: 10.1378/chest.07-2444Goldin JG, Lynch DA, Strollo DC, et al. High-resolution CT scan findings in patients with symptomatic scleroderma-related interstitial lung disease. Chest. 2007;134:358-67. doi: 10.1378/chest.07-2444Овсянникова ОБ. Клинико-инструментальная характеристика интерстициального поражения легких при системной склеродермии: Автореф. дис. … канд. мед. наук. Москва; 2017. С. 10-5 [Ovsyannikova OB. Kliniko-instrumental'-naya kharakteristika interstitsial'nogo porazheniya legkikh pri sistemnoiОвсянникова ОБ. Клинико-инструментальная характеристика интерстициального поражения легких при системной склеродермии: Автореф. дис. … канд. мед. наук. Москва; 2017. С. 10-5 [Ovsyannikova OB. Kliniko-instrumental'-naya kharakteristika interstitsial'nogo porazheniya legkikh pri sistemnoisklerodermii [Clinical and instrumental characteristics of interstitial lung lesions in systemic scleroderma]: Author's abstract. dis. ... cand. med. science. Moscow; 2017. P. 10-5 (In Russ.)].sklerodermii [Clinical and instrumental characteristics of interstitial lung lesions in systemic scleroderma]: Author's abstract. dis. ... cand. med. science. Moscow; 2017. P. 10-5 (In Russ.)].Wells AU. High-resolution computed tomography and scleroderma lung disease. Rheumatology. 2008;47 Suppl. 5:59-61. doi: 10.1093/rheumatology/ken271Wells AU. High-resolution computed tomography and scleroderma lung disease. Rheumatology. 2008;47 Suppl. 5:59-61. doi: 10.1093/rheumatology/ken271Van der Bruggen-Bogaarts BAHA, Broerse JJ, Lammers JWJ, at al. Radiation exposure in standard and high-resolution chest CT scans. Chest. 1995;107:113-5. doi: 10.1378/chest.107.1.113Van der Bruggen-Bogaarts BAHA, Broerse JJ, Lammers JWJ, at al. Radiation exposure in standard and high-resolution chest CT scans. Chest. 1995;107:113-5. doi: 10.1378/chest.107.1.113Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-84. doi: 10.1056/NEJMra072149Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-84. doi: 10.1056/NEJMra072149Mayo JR. CT evaluation of diffuse infiltrative lung disease: dose considerations and optimal technique. J Thorac Imaging. 2009;24:252-9. doi: 10.1097/RTI.0b013e3181c227b2Mayo JR. CT evaluation of diffuse infiltrative lung disease: dose considerations and optimal technique. J Thorac Imaging. 2009;24:252-9. doi: 10.1097/RTI.0b013e3181c227b2Behr J, Furst DE. Pulmonary function tests. Rheumatology. 2008;47 Suppl. 5:65-7. doi: 10.1093/rheumatology/ken313Behr J, Furst DE. Pulmonary function tests. Rheumatology. 2008;47 Suppl. 5:65-7. doi: 10.1093/rheumatology/ken313

The authors declare that there are no conflicts of interest present.