38例呼吸道受累的复发性多软骨炎临床分析  

Clinical analysis of 38 patients with respiratory involvement in relapsing polychondritis

作　　者：高冠民[1] 江东彬 蒋莉[2] 李艳敏[1] 郑晓龙[1] 张蕾蕾[1] 刘升云[1] 郑朝晖[1] 阚全程[3] 

机构地区：[1]郑州大学第一附属医院风湿免疫科(河南省高等学校临床医学重点学科开放实验室),450052 [2]郑州大学第一附属医院放射治疗部,450052 [3]郑州大学第一附属医院药学部,450052

出　　处：《中国医师进修杂志》2016年第7期590-592,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：分析复发性多软骨炎（RPC）患者呼吸道受累的临床特点。方法回顾性分析38例呼吸道（喉、气管和支气管）受累的复发性多软骨炎患者的临床资料。结果呼吸道受累在RPC患者的发生率为51.35%（38/74），最常见的症状为咳嗽、喘息、胸闷和呼吸困难。呼吸道受累RPC患者红细胞沉降率（ESR）、C反应蛋白（CRP）、纤维蛋白原、D-二聚体的升高发生率和类风湿因子（RF）阳性发生率明显高于无呼吸道受累RPC患者[47.37%（18/38）比30.56%（11/36）、52.63%（20/38）比33.33%（12/36）、31.58%（12/38）比25.00%（9/36）、21.05%（8/38）比13.89%（5/36）、36.84%（14/38）比5.56%（2/36）]，差异有统计学意义（P＜0.05）。CT是发现呼吸道受累的最重要检查方法，核磁共振可以早期发现气道软骨损害，喉镜和气管镜可发现气道黏膜和软骨损害，组织学可见以淋巴细胞和中性粒细胞为主的浸润，部分患者可出现气道不典型增生，甚至癌变。治疗以糖皮质激素联合免疫抑制剂为主。气道狭窄和合并感染是造成预后不良的最主要原因。结论呼吸道受累在RPC中并不少见，对有呼吸道症状的患者应积极进行影像学、喉镜和气管镜检查以早期发现呼吸道受累，早期给予糖皮质激素联合免疫抑制剂治疗是取得良好预后的关键。Objective To analyze the clinical characteristics of respiratory involvement in relapsing polychondritis（RPC）. Methods The clinical data of 38 patients with respiratory （larynx, trachea and bronchus） involvement in RPC were retrospectively analyzed. Results The incidence of respiratory involvement in patients with RPC was 51.35%（38/74）, and the most common symptoms were cough, wheezing, chest tightness and dyspnea. The incidences of erythrocyte sedimentation rate （ESR） increasing, C- reactive protein （CRP） increasing, fibrinogen increasing, D- dimer increased and rheumatoid factor （RF） positive in patients with respiratory involvement were significantly higher than those in patients without respiratory involvement： 47.37% （18/38） vs. 30.56% （11/36）, 52.63% （20/38） vs. 33.33% （12/36）, 31.58% （12/38） vs. 25.00% （9/36）, 21.05% （8/38） vs. 13.89% （5/36） and 36.84%（14/38） vs. 5.56% （2/36）, and there were statistical differences （P〈0.05）. CT was the main method to discover the respiratory involvement, and MRI could detect early cartilage inflammation lesions. Laryngoscope and bronchoscope could early detect mucosa and cartilage damage. Pathology was given priority to lymphocytes and neutrophils infiltration. Some patients had epithelium metaplasia and even canceration. Primary treatment methods were glucocorticoids combined with immunosuppressant. Airway stenosis and infection was the main factors influencing the prognosis of patients. Conclusions The respiratory involvement is not uncommon in RPC, and early CT, MRI, laryngoscope and bronchoscopeexamination is an important means of early diagnosis.Early glucocorticoid combined immunosuppressive therapy is the key to achieve good prognosis.

关 键 词：多软骨炎  复发性 体征和症状 回顾性研究 

分 类 号：R56[医药卫生—呼吸系统] R681.3[医药卫生—内科学]