类风湿关节炎合并肺间质病变171例临床特点分析  

Clinical characteristics and analysis of the rheumatoid arthritis-associated interstitial lung disease

作　　者：戴冰冰[1] 杨娉婷[2] 刘畅[1] 雷蕾[1] 张昊[1] 

机构地区：[1]大连医科大学附属大连市中心医院风湿免疫科,辽宁大连116033 [2]中国医科大学附属第一医院风湿免疫科,沈阳110001

出　　处：《中国实用内科杂志》2015年第3期254-256,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家自然基金(81271324);辽宁省自然科学基金项目(201202250)

摘　　要：目的探讨类风湿关节炎（RA）患者并发肺间质病变（ILD）（RA-ILD）的临床特点。方法回顾性分析2012年1月至2014年6月大连市中心医院风湿免疫病房住院的171例RA患者,按照是否合并肺间质病变分为单纯RA组（145例）和RA-ILD组（26例）,比较两组临床资料、实验室检查、影像学检查等指标。结果 ILD在RA中的发生率为15.2%。与单纯RA患者相比,RA-ILD患者发病年龄大,病程长,疾病活动度评分（DAS28）高（P均〈0.05）。其中15例（57.7%）患者在检出ILD时无呼吸系统症状。实验室检查指标中,红细胞沉降率（ESR）、C-反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸多肽抗体（ACPA）在RA-ILD组均显著增高（P均〈0.05）。多因素分析显示,年龄（OR=1.089,95%CI 1.036-1.128,P〈0.05）和RF（OR=3.489,95%CI 1.352-8.952,P〈0.05）是RA-ILD的危险因素。结论ILD是RA的常见并发症,与疾病的高活动度相关。年龄和RF是其发生的危险因素。Objective To investigate the clinical characteristics of rheumatoid arthritis-associated interstitial lung disease（RAILD）. Methods A total of 171 RA patients were classified as 2 groups： without RA group（RA-no ILD,n = 145） and the RA-ILD（n= 26） group,and their clinical and laboratory data were analyzed retrospectively. Results The incidence of RA-ILD was 15.2%. The patients with RA-ILD had older age,longer disease duration and higher DAS28 scores than the RA patients without ILD（P〈0.05）. A proportion of 57.7% RA-ILD patients were asymptomatic at the onset of the diseases. Higher levels of erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,rheumatoid factor（RF） as well as anti-cyclic citrullinated peptide（anti-CCP） antibodies were found in the RA-ILD group than in the RA-no ILD group（P〈0.05）. Multivariable analysis indicated that the correlative risk factors of RA-ILD were age and RF levels. Conclusion The presence of ILD is a common complication of RA and positive correlation exists between ILD and high disease activity of RA. Both of age and increased RF levels are risk factors.

关 键 词：关节炎 类风湿 肺间质病变 

分 类 号：R593.22[医药卫生—内科学]