类风湿性关节炎继发肺间质纤维化19例临床分析  

Analysis of clinical characteristics of 19 patients with rheumatoid arthritis complicated with the secondary pulmonary fibrosis.

作　　者：张尽晖[1] 王琪[1] 王镇山[1] 

机构地区：[1]大连医科大学附属第二医院呼吸内科,辽宁大连116023

出　　处：《中国实用内科杂志》2009年第S1期38-40,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨类风湿性关节炎(RA)继发肺间质纤维化(IPF)的临床特点、危险因素、肺功能、胸部CT及治疗预后,加深对RA继发IPF(RA-IPF)的认识。方法回顾我院2002年3月至2008年12月19例收治RA-IPF患者的临床资料,包括吸烟史、类风湿因子(RF)、血气分析、胸部CT、肺功能检查等,分析RA-IPF患者的特点。结果 19例RA-IPF患者中,男女比例为1:1.7,有长期吸烟史者并发肺间质纤维化的时间早于无吸烟史者;19例患者有干咳,18例出现胸闷症状,低氧血症者10例,CT发现网状纤维化改变者达94.7%;本组死亡2例,均死于呼吸衰竭。结论 RA-IPF的性别比例可能与不同的病理类型有关,吸烟可能为RA-IPF的重要危险因素,CT发现网状纤维化是本病主要特点。HRCT的诊断特异性很高,但需注意部分患者可不呈现蜂窝状改变。治疗若无禁忌,应首选糖皮质激素治疗,大部分症状有所好转。Objective To explore the clinical characteristics,risk factor,pulmonary function,computed tomography (CT)and treatment of Interstitial pulmonary fibrosis(IPF) in rheumatoid arthritis(RA) to build up knowledge for early diagnosis. Methods The clinical dates of 19 admitted Interstitial pulmonary fibrosis in RA(RA-IPF) patients from March 2002 to December 2008 were analyzed retrospectively including smoking history,rheumatoid factor(RF), blood-gas analysis,chest CT,pulmonary function tests.Results Among the 19 RA patients with IPF,male/female ratio was 1:1.714.Compared with patients of RA without histories of cigarette smoking,patients with smoking had statistically significantly earlier complicating IPF.There were 19 cases with nonproductive coμgh,18 cases with chest distress and 10cases with hypoxemia.From spiral CT scan of lung,94.7%cases showed reticular fibriform changing.2 deaths occurred in this study.The cause of the death was respiratory failure.Conclusions The histopathologic type of RA-IPF lead to the difference of male/female ratio.Smoking is probably one of the potential risk factors.Reticular fibriform changing was considered of the main characteristic of the disease.There were no apparent honeycomb formations on HRCT in some patients in spite of the specificity of HRCT is approving.Glucocorticoid should be used first,if no contraindication, and most conditions get better.

关 键 词：类风湿性关节炎 肺间质纤维化 

分 类 号：R563.9[医药卫生—呼吸系统] R593.22[医药卫生—内科学]