【摘要】：目的比較類風(fēng)濕關(guān)節(jié)炎(RA)繼發(fā)不同類型肺間質(zhì)病變(ILD)患者的臨床、肺部影像以及肺功能特點(diǎn)。方法選擇2007年1月至2013年4月北京大學(xué)第一醫(yī)院風(fēng)濕免疫科或呼吸科住院經(jīng)高分辨CT(HRCT)確診、資料完整的RA-ILD的患者51例,收集臨床、血?dú)夥治�、RA血清學(xué)及肺功能等指標(biāo),比較不同肺HRCT分類患者臨床特點(diǎn)的差異。結(jié)果肺HRCT下尋常型間質(zhì)性肺炎(UIP)改變13例,非特異性間質(zhì)性肺炎(NSIP)改變10例,機(jī)化性肺炎(OP)改變8例,無法分類20例,各組在性別、年齡、吸煙史、血清學(xué)指標(biāo)方面差異無統(tǒng)計(jì)學(xué)意義;12例患者在確診RA前出現(xiàn)ILD,其余39例患者ILD出現(xiàn)在RA診斷后或與RA同時(shí)出現(xiàn),RA診斷后繼發(fā)NSIP的中位時(shí)間間隔為1.45年(IQR 4.37,范圍0~9.75年),早于其他類型ILD患者(P0.05),OP患者的Pa O2[(7.65±1.38)k Pa]低于其他類型ILD患者[UIP(10.23±1.58)mm Hg,NSIP(9.56±3.05)mm Hg,無法分類(10.41±2.39)mm Hg,P0.05]。不同類型ILD患者的肺功能水平比較差異無統(tǒng)計(jì)學(xué)意義。Logistic回歸分析發(fā)現(xiàn),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出現(xiàn)Ⅰ型呼吸衰竭的獨(dú)立危險(xiǎn)因素。結(jié)論 UIP是RA-ILD患者經(jīng)肺HRCT可以明確分型間質(zhì)病中最常見的類型,部分患者在RA發(fā)病后短期內(nèi)出現(xiàn)ILD、NSIP、OP以及ILD病程是出現(xiàn)Ⅰ型呼吸衰竭的危險(xiǎn)因素,因此,RA患者應(yīng)積極篩查ILD。
[Abstract]:Objective to compare the clinical features, pulmonary imaging and pulmonary function of (ILD) patients with rheumatoid arthritis (RA) secondary to different types of pulmonary interstitial lesions. Methods from January 2007 to April 2013, 51 patients with RA-ILD diagnosed by high resolution CT (HRCT) were selected from Rheumatological Immunology Department or Respiratory Department, first Hospital of Peking University. Clinical data were collected, serum gas was analyzed for RA serology and pulmonary function. To compare the clinical characteristics of different lung HRCT classification patients. Results there were 13 cases of (UIP) changes of interstitial pneumonia vulgaris, 10 cases of (NSIP) change of nonspecific interstitial pneumonia, 8 cases of (OP) change of organic pneumonia and 20 cases of no classification under pulmonary HRCT. There was no significant difference in serological parameters between 12 patients with ILD before the diagnosis of RA. The median interval of NSIP after diagnosis of RA or with RA was 1.45 years (IQR 4.37, range 0, 9.75). Pao _ 2 [(7.65 鹵1.38) k Pa)] was earlier than that in other types of ILD patients (P0.05) and lower than that in other types of ILD patients [UIP (10.23 鹵1.58) mm HgN NSIP (9.56 鹵3.05) mm Hg,) could not be classified into (10.41 鹵2.39) mm HgP (P0.05)]. Logistic regression analysis showed that the course of ILD (ORL 1.45195 CI 1.03222.040 P0. 032) and op (OR17.4331 95 CI 1.901 159.811P0.011) were independent risk factors of type 鈪，

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