结缔组织病相关间质性肺病合并肺部感染临床特点  

Complicated pulmonary infection clinical characteristics of connective tissue disease related interstitial lung disease

作　　者：马芹[1] 徐建华[1] 王芬[1] 徐胜前[1] 连莉[1] 

机构地区：[1]安徽医科大学第一附属医院风湿免疫科,合肥230022

出　　处：《临床内科杂志》2016年第2期124-127,共4页Journal of Clinical Internal Medicine

摘　　要：目的通过回顾性分析结缔组织病相关间质性肺病（CTD—ILD）合并肺部感染的临床特点，探讨其危险因素。方法分析219例CTD-ILD住院患者的临床资料，根据有无合并肺部感染分为感染组（A组）和无合并感染组（B组），比较两组临床及实验室等指标差异，分析其相关性。结果（1）CTD—ILD合并肺部感染发生率为43．38％（95／219例），其中多发性肌炎／皮肌炎（PM／DM）、系统性红斑狼疮（SLE）和系统性血管炎（SV）最为多见；A组出现呼吸衰竭明显高于B组（P〈0．05），死亡5例，均为感染组。（2）A组发热、咳痰；血中性粒细胞、红细胞沉降率（ESR）、C反应蛋白（CRP）及铁蛋白升高；中重度限制性通气障碍及大剂量激素使用均明显高于B组且与肺部感染呈正相关（P均（0．05）；淋巴细胞数、白蛋白和血氧分压（PO：）明显低于B组，与肺部感染呈负相关（P均〈0．05）；两组肺部HRCT表现无明显差异（P〉0．05）。（3）病毒感染22例（23．2％），痰培养阳性率18例（18．9％，革兰氏阴性杆菌14例、真菌4例）。（4）Logistic多元回归分析：咳嗽咳痰、CRP升高、淋巴细胞及白蛋白降低是诊断CTD—ILD合并肺部感染的危险因素（P均〈0．05）。结论CTD—ILD易合并肺部感染，且明显增加肺功能损伤、呼吸衰竭及死亡的发生。淋巴细胞减少、白蛋白降低及CRP升高是合并感染的独立危险因素。Objective To explore the risk factors of CTD-ILD with lung infection, the clinical characteristics were retrospectively analyzed. Methods Two hundred and nineteen CTD-ILD patients were chosen and divided into infection group （ group A） and non-infection group （ group B） according to whether pulmonary infection existed. Compared two groups of clinical and laboratory index differences, such as analysised of the correlation. Results （ 1 ） Among 219 patients, the prevalence of pulmonary infection in CTD-ILD was 43.38% （95/219 cases）. The top 3 of disease were PM/DM,SLE,SV. Five dead patients all belonged to Group A. （2） These clinical characteristics in group A were significantly higher than group B,including the increased of neutrophilic granulocyte, ESR, CRP, serum ferritin, and the incidence of fever, expectoration, moderate/severe restrictive ventilatordys dysfunction, use of high doses of glucocorticoid, those were positively related to pulmonary infection（P 〈 0.05 ）. Blood lymphocytes, albumin and PO2 in group A were significantly lower than those in group B, those were negatively related to pulmonary infection（P 〈 0.05 ）. HRCT lesions showed that there were no statistical difference between two groups （ P 〉 0. 05 ）. （ 3 ） 22 cases virus infection （ 23.2% ）, 18 cases sputum culture positive （ 18.9 %, 14 Gram-negative bacillus cases, 4 fungal infection cases ）. （4）Logistic multiple regression analysis showed that CTD-ILD complicated pulmonary infection（ P 〈 0.05 ） was significantly related to cough and expectoration, CRP,lymphocytes and albumin. Conclusion Patients with CTD-ILD were easy to merge lung infection, which significantly increased the occurrence of lung function damage, respiratory failure and death,low albumin and high CRP were independent risk factors for infection.

关 键 词：结缔组织病 间质性肺病 肺部感染 

分 类 号：R734.2[医药卫生—肿瘤]