类风湿关节炎患者肺间质病变的临床特点及血清细胞因子的变化  

Clinical observation of rheumatoid arthritis associated interstitial lung disease patients and changes of serum cytoidnes thereof

作　　者：菅向东[1] 郭广冉[1,2] 阮艳君[1] 赵波[1] 王玉彩[1,3] 宁琼[1,4] 张源潮[5] 

机构地区：[1]山东大学齐鲁医院风湿科,济南250012 [2]山东中医药大学第二附属医院职业病科 [3]山东省齐河县人民医院内科 [4]山东省济南医院职业病科 [5]山东大学山东省立医院风湿科

出　　处：《中华医学杂志》2008年第27期1884-1887,共4页National Medical Journal of China

基　　金：山东省科技厅计划项目（2003857）

摘　　要：目的探讨类风湿关节炎（RA）肺间质病变（RA-ILD）的临床特点和血清转化生长因子（TGF）-β1、肿瘤坏死因子（TNF）-α、胰岛素样生长因子（IGF）-1和血小板源性生长因子（PDGF）．AB的变化规律。方法随机观察比较30例RA—ILD病人和35例RA病人，主要观察指标有性别、年龄、病程、收缩压、舒张压、呼吸次数、休息痛，病人评价和医生评价，晨僵时间、握力、压痛关节数、压痛关节指数、肿胀关节数、肿胀关节指数，关节功能评价，手X线分期，日常生活能力（HAQ）、肺部高分辨CT（HRCT）、肺功能、动脉血气分析等指标。对所有病人测定了细胞因子TGF--β1、TNF-α、IGF-1和PDGF—AB浓度。结果与RA病人相比，RA—ILD组病人年龄偏大、病程较长，休息痛、病人评价和医生评价较重，晨僵时间长，握力小，压痛关节数和压痛关节指数、肿胀关节数和肿胀关节指数均较高，关节功能评价和手x线分期较严重，日常生活能力较差（P〈0．05，P〈0．01）。RA—ILD组病人红细胞沉降率较快，血清C反应蛋白较高、类风湿因子滴度高、球蛋白含量高，肺动脉压测定值高等（P〈0．01）。RA-ILD病人主要呼吸系统表现有咳嗽、咳痰、胸闷、气短、胸痛、呼吸音改变、Velcro哕音、活动后呼吸困难等。RA—ILD和RA病人在VC、FVC、MMF和DLCO指标差异有统计学意义（P〈0．01）。RA-ILD病人主要表现为弥散功能下降（83％）、限制性通气障碍（63％），阻塞性通气障碍（26％）、小气道功能受损（42％），混合性肺功能障碍（16％）。与正常对照组相比，RA—ILD病人血清TGF-β1、TNF-α、IGF-1、PDGF—AB水平明显增高（P〈0．01），RA病人上述细胞因子也明显升高（P〈0．01）。与RA病人相比，RA—ILD病人血清TGF-β1、TNF-α、IGF-1、PDGF—AB明显增高（P〈0．01）。结论RA—ILD病人多项临床活动指标较RAObjective To observe the clinical feature of rheumatoid arthritis associated interstitial lung disease （RA-ILD） patients and changes of serum cytokines tumor growth factor （TGF）-β1, tumor necrosis factor （TNF）-α, insulin-like growth factor （IGF）-1, and platelet derived growth factor （PDGF）- AB. Methods The clinical manifestations, lung high resolution CT （ HRCT）, lung functions, blood gas and other relative laboratory findings of 30 RA-ILD patients and 35 RA patients were observed. ELASA was used to detect the levels of TGF-β1, TNF-α, IGF-1, and PDGF-AB. Thirty healthy volunteers were observed too as controls. Results The clinical manifestations of RA-ILD patients were more serious than those of the RA patients. The ESR was faster, the serum C-reactive protein, rheumatoid factor （RF） , and globulin levels higher, and pulmonary arterial pressure higher too in the RA-ILD patients than in the RA patients（ all P 〈 0. 01 ） . The main respiratory manifestations of the RA-ILD patients were cough,expectoration, chest distress, short breath, chest pain, change of breath sounds, Velcro rales, and dyspnea. The main lung HRCT findings included thickening of interlobular septum and bronchial wall, pachynsis pleurae, mosaic sign, bronchiectasis, emphysema, patching shadow, honeycombing, fibrous scar, etc. Pulmonary function test showed that the levels of vital capacity, forced vital capacity, maximum midexpiratory flow, and diffusing capacity of the lung for carbon monoxide of the RA-ILD patients were all significantly lower than those of the RA patients（ all P 〈0.01 ）. Arterial gas test showed that the PO2 of the RA-ILD patients was significantly lower than that of the RA patients （P 〈 0. 01 ）. The TGF-β1 ; TNF-α, IGF-1, and PDGF-AB of both the RA-ILD and RA patients were all significantly higher than those of the healthy volunteers （all P 〈0. 01 ）, and the levels of these cytokines of the RA-ILD patients were all higher than those of the RA patients（ all P 〈 0. 01

关 键 词：类风湿关节炎 肺间质病变 转化生长因子-Β1 肿瘤坏死因子-Α 

分 类 号：R686[医药卫生—骨科学]