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目的比较类风湿关节炎(RA)继发不同类型肺间质病变(ILD)患者的临床、肺部影像以及肺功能特点。方法选择2007年1月至2013年4月北京大学第一医院风湿免疫科或呼吸科住院经高分辨CT(HRCT)确诊、资料完整的RA-ILD的患者51例,收集临床、血气分析、RA血清学及肺功能等指标,比较不同肺HRCT分类患者临床特点的差异。结果肺HRCT下寻常型间质性肺炎(UIP)改变13例,非特异性间质性肺炎(NSIP)改变10例,机化性肺炎(OP)改变8例,无法分类20例,各组在性别、年龄、吸烟史、血清学指标方面差异无统计学意义;12例患者在确诊RA前出现ILD,其余39例患者ILD出现在RA诊断后或与RA同时出现,RA诊断后继发NSIP的中位时间间隔为1.45年(IQR 4.37,范围0~9.75年),早于其他类型ILD患者(P<0.05),OP患者的Pa O2[(7.65±1.38)k Pa]低于其他类型ILD患者[UIP(10.23±1.58)mm Hg,NSIP(9.56±3.05)mm Hg,无法分类(10.41±2.39)mm Hg,P<0.05]。不同类型ILD患者的肺功能水平比较差异无统计学意义。Logistic回归分析发现,ILD病程(OR=1.451,95%CI1.032~2.040,P=0.032)、NSIP(OR=8.326,95%CI 1.243~55.778,P=0.029)以及OP(OR=17.431,95%CI 1.901~159.811,P=0.011)是RA-ILD出现Ⅰ型呼吸衰竭的独立危险因素。结论 UIP是RA-ILD患者经肺HRCT可以明确分型间质病中最常见的类型,部分患者在RA发病后短期内出现ILD、NSIP、OP以及ILD病程是出现Ⅰ型呼吸衰竭的危险因素,因此,RA患者应积极筛查ILD。
Objective To compare the clinical, pulmonary and pulmonary function of patients with different types of interstitial lung disease (RA) secondary to rheumatoid arthritis (RA). Methods From January 2007 to April 2013, 51 patients with RA-ILD diagnosed by Department of Rheumatology or Respiratory Department of Peking University First Hospital were enrolled in this study. Clinical, blood gas analysis, RA Serology and lung function and other indicators to compare the clinical features of different pulmonary HRCT classification differences. Results There were 13 cases of abnormal interstitial pneumonia (UIP) under lung HRCT, 10 cases of nonspecific interstitial pneumonia (NSIP), 8 cases of opportunistic pneumonia (OP) , Age, smoking history and serological parameters. There was no significant difference in ILD before the diagnosis of RA among the 12 patients and ILD in the remaining 39 patients after RA or RA, and the median of secondary NSIP after RA diagnosis PaO2 [(7.65 ± 1.38) kPa] was significantly lower in OP patients than in other types of ILD patients (P <0.05) at intervals of 1.45 years (IQR 4.37, range, 0 to 9.75 years) (10.23 ± 1.58) mm Hg and NSIP (9.56 ± 3.05) mm Hg, respectively (10.41 ± 2.39 mm Hg, P <0.05). There was no significant difference in lung function between different types of ILD patients. Logistic regression analysis showed that the duration of ILD (OR = 1.451,95% CI 1.032-2.040, P = 0.032), NSIP (OR = 8.326,95% CI 1.243-55.778, P = 0.029) and OP (OR = 17.431,95 % CI 1.901 ~ 159.811, P = 0.011) was an independent risk factor for type Ⅰ respiratory failure in RA-ILD. Conclusions UIP is the most common type of interstitial lung disease in RA-ILD patients by pulmonary HRCT. Some patients may have IL-1, NSIP, OP and ILD in short-term after RA onset, Therefore, RA patients should actively screen for ILD.