本文選題：類風濕關(guān)節(jié)炎 + 間質(zhì)性肺病��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討RA-ILD患者的臨床特點及血清KL-6檢測在RA-ILD中的意義。方法:回顧性分析2015年4月-2017年1月我院住院治療的RA患者的臨床資料。根據(jù)胸部HRCT結(jié)果分為RA-ILD組和RA-non-ILD組,所有患者均行胸部HRCT,健康對照組,CLIA法檢測血清KL-6水平.采用獨立樣本T檢驗比較各組間血清KL-6水平差異,采用獨立樣本T檢驗或方差分析比較RA-ILD組及RA-non-ILD組臨床、實驗室結(jié)果差異,采用直線相關(guān)分析將RA-ILD組血清KL-6水平與臨床指標的進行相關(guān)性分析。結(jié)果:1.RA-ILD患者臨床結(jié)果(1)一般情況:81例RA患者中,男22例、女59例,年齡30~80歲。其中RA-ILD組患者39例,男13例,女26例,年齡44~80歲,平均(62±7.8)歲,病程0.2~30年、平均(7.66±7.64)年。(2)RA-ILD組患者臨床表現(xiàn):RA-ILD患者中合并呼吸系統(tǒng)癥狀者僅占少數(shù),且癥狀輕微。39例患者呼吸系統(tǒng)癥狀按比例從高到底分別為:干咳3例(7.7%)、活動后胸悶氣短2例(5.1%)、VelcroUp音2例(5.1%)。(3)RA-ILD組患者影像學結(jié)果(1)RA-ILD組影像學改變:RA-ILD組患者胸部HRCT改變依次為小葉間隔增厚24例(61.5%)、纖維條索影23例(59%)、磨玻璃影19例(48.7%)、斑片滲出/實變影7例(17.9%)、牽拉性支氣管擴張7例(17.9%)、網(wǎng)格影6例(15.4%)、蜂窩影2例(5.1%)、胸膜下線影1例(2.6%)。(2)RA-ILD組影像分型結(jié)果:UIP型7例(17.95%),NSIP型13例(33.33%),未定型19例(48.72%)。(3)RA-ILD組影像學分級結(jié)果:I級37例(94.9%),II級2例(5.1%)2.RA-ILD組與RA-non-ILD組比較結(jié)果(1).臨床基本情況比較:RA-ILD組患者年齡高于RA-non-ILD組(P0.05)(2)實驗室指標比較:兩組在WBC、LDH、ESR、CRP、免疫球蛋白、補體、RF滴度、抗CCP抗體水平上無統(tǒng)計學差異(P0.05)(3)腫瘤標記物比較:RA-ILD組患者CA19-9水平高于RA-non-ILD組(P0.05)(4)血清KL-6比較結(jié)果:RA-ILD組患者的血清KL-6(U/ml)水平為(269.72±210.24),高于RA-non-ILD組血清KL-6水平(76.93±80.32)和健康對照組(99.23±35.80),且差異有統(tǒng)計學意義(P0.05)。3.RA-ILD組患者血清KL-6水平與臨床指標的相關(guān)性(1)臨床基本情況:血清KL-6與年齡、發(fā)病年齡、病程、關(guān)節(jié)腫脹數(shù)及壓痛數(shù)均無相關(guān)性(P0.05)(2)實驗室指標:血清KL-6水平與LDH呈正相關(guān)(r=0.756,P0.05),與PLT、補體C3呈負相關(guān)(r分別為-0.342、-0.497,P0.05)。(3)腫瘤標記物:血清KL-6水平與Fer呈正相關(guān)(r=0.629,P0.01)結(jié)論:1.RA-ILD患者呼吸系統(tǒng)表現(xiàn)不典型,癥狀隱匿,需及早完善胸部HRCT檢查。2.年齡、CA19-9升高與RA-ILD的發(fā)生密切相關(guān)。3..血清KL-6水平可作為RA-ILD診斷的血清學指標之一。
[Abstract]:Objective: to investigate the clinical features of RA-ILD patients and the significance of serum KL-6 detection in RA-ILD. Methods: the clinical data of RA patients hospitalized in our hospital from April 2015 to January 2017 were analyzed retrospectively. According to the results of chest HRCT, all patients were divided into RA-ILD group and RA-non-ILD group. The serum KL-6 levels were compared by independent sample T test, and the clinical and laboratory results of RA-ILD group and RA-non-ILD group were compared by independent sample T test or ANOVA. Linear correlation analysis was used to analyze the correlation between serum KL-6 level and clinical indexes in RA-ILD group. Results 1. The clinical results of RA-ILD patients were as follows: 1) of 81 patients with RA, 22 were males and 59 were females, aged 30 to 80 years. There were 39 patients in RA-ILD group, 13 males and 26 females, aged 4480 years, with an average age of 62 鹵7.8 years. The course of disease was 0.2-30 years (mean 7.66 鹵7.64) years. The respiratory symptoms of 39 patients with mild symptoms were as follows: dry cough, 3 cases, 7. 7%, chest tightness, shortness of breath, 2 cases, 5. 1% VelcroUp, 2 cases, 5. 1%, 2 cases, 5. 1%, 1% RA-ILD group, 2 cases, 1% RA-ILD group, 2 cases, 1% RA-ILD group. 24 cases with thickening of interlobular septum, 23 cases with fibrous cord shadow, 19 cases with grinding glass shadow and 48.7%, 7 cases with macular exudation / solid shadow, 7 cases with tractive bronchiectasis, 7 cases with tractive bronchiectasis, 6 cases with reticular shadow, 5 cases with honeycomb, 2 cases with honeycombing, 1 case with subpleural shadow, 1 case with subpleural line shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow and 1 case with subpleural shadow. The results of imaging classification were as follows: 7 cases of UIP type (17. 95%) and 13 cases of NSIP type (13 cases) were divided into 3. 33 degrees, 19 cases of which were not finalized. The results of imaging grading in the group of 37 cases with grade I of 7 cases with grade 2 of grade 2 with grade 2 of grade 2 of grade 2 with that of the group of RA-non-ILD were compared with that of the group of RA-non-ILD. Comparison of the basic clinical conditions: the age of the patients in the 10% RA-ILD group was higher than that in the RA-non-ILD group (P 0.05). The laboratory indexes were as follows: the titer of CRP, immunoglobulin and complement RF in the two groups were higher than that in the RA-non-ILD group. There was no significant difference in the level of anti CCP antibody (P0.05T3) comparison of tumor markers: the CA19-9 level of the patients in the W RA-ILD group was higher than that in the RA-non-ILD group (P0.05 + 4). The results of serum KL-6 comparison showed that the serum KL-6 UP / ml level of the patients in the 10% RA-ILD group was 269.72 鹵210.24, which was higher than that in the RA-non-ILD group (76.93 鹵80.32) and the healthy control group (99.23 鹵35.80), and the level of serum KL-6U / ml was higher than that in the RA-non-ILD group (76.93 鹵80.32). The correlation between serum KL-6 level and clinical indexes in RA-ILD group (1) basic clinical information: serum KL-6 and age. Age of onset, course of disease, There was no correlation between the number of joint swelling and tenderness (P0.05 / 2) Laboratory index: serum KL-6 level was positively correlated with LDH (0.756U P0.05A), and negatively correlated with LDH and C3 (r = -0.342- 0.497n P0.05n. 3) tumor marker: serum KL-6 level was positively correlated with Fer (0.629 / P0.01). Conclusion: 1.RA-ILD patients have a negative correlation. The respiratory system is not typical. The symptom is concealed, the chest HRCT examination should be improved as soon as possible. 2. The increase of age CA19-9 was closely related to the occurrence of RA-ILD. Serum KL-6 level can be used as one of the serological markers for the diagnosis of RA-ILD.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R593.22;R563

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