伴发大量液气胸的无关节症状类风湿关节炎一例及文献复习  

Asymptomatic rheumatoid athritis with massive hydropneumothorax:one case report and literature review

作　　者：王佳鑫 于墨池 刘俊秀[1] 郑伟[1] 陈愉[1] 赵立[1] Wang Jiaxin;Yu Mochi;Liu Junxiu;Zheng Wei;Chen Yu;Zhao Li(Department of Respiratory and Critical Care Medicine,Shengjing Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院呼吸与危重症医学科,沈阳110000

出　　处：《国际呼吸杂志》2021年第9期671-677,共7页International Journal of Respiration

摘　　要：目的提高临床医师对伴发大量液气胸且无关节症状类风湿关节炎的认识,减少临床漏诊及误诊率。方法回顾1例伴发大量液气胸且无关节症状类风湿关节炎患者的临床表现及影像学特点,同时以"类风湿关节炎""气胸"为检索词检索万方数据库,以"rheumatoid arthritis""pneumothorax"为检索词检索PubMed数据库,检索时间为2000年1月至2019年12月。结果本例患者为老年男性,以咳嗽、咳痰、发热、喘息等类感染样表现为首发症状就诊,无明显关节症状,入院时误诊为"慢性阻塞性肺疾病急性加重期、肺炎",常规抗感染治疗效果不理想,在院期间出现大量胸腔积液,后伴发严重气胸,分别行胸腔置管引流术及闭式引流术治疗,患者症状逐渐好转。血清学类风湿因子、抗环瓜氨酸肽抗体检测均阳性,胸部CT动态分析病灶呈游走样改变,修订诊断为"类风湿肺合并慢性阻塞性肺疾病急性加重期、肺源性心脏病",应用甲强龙治疗后临床表现及影像学改变好转。共检索到相关中文文献3篇,英文文献49篇,经筛选整理共有10例类风湿关节炎伴发气胸患者。其中6例因靠近胸膜处类风湿结节破溃进入胸腔致自发性气胸;3例因长期服用治疗类风湿关节炎药物致自发性气胸;仅有1例患者自发性气胸出现在关节症状前;有2例患者在气胸基础上并发了支气管胸膜瘘。结论肺脏因其具有丰富的结缔组织和血管系统成为继心血管系统后类风湿关节炎最常侵犯的关节外器官,伴发大量液气胸且无明显关节症状的类风湿关节炎病例罕见。临床医师需结合临床表现、实验室检查及影像学特点准确诊断,以免漏诊、误诊而延误治疗。Objective To improve clinicians′understanding of rheumatoid arthritis with massive hydropneumothorax and without joint symptoms,and reduce the rates of missed diagnosis and misdiagnosis.Methods The clinical manifestations and imaging features of one case of rheumatoid arthritis with massive hydropneumothorax and without joint symptoms were reviewed.Meanwhile,the key words,"rheumatoid arthritis"and"pneumothorax",were retrieved and screened through Wanfang Medical database in Chinese and PubMed datebase in English respectively,from January 2000 to December 2019.Results The reported patient was an elderly male,appeared cough,expectoration,fever,wheezing and other infectious symptoms as the first symptoms,without obvious joint symptoms,previously misdiagnosed as"acute exacerbation of chronic obstructive pulmonary disease,pneumonia".The patient showed a large amount of pleural effusion during the period of hospitalization after an useless result of conventional anti-infection treatment,accompanying with severe pneumothorax,who was gradually recovered after drainage.The serological rheumatoid factor and anti-cyclic peptide containing citrulline antibody detection were both positive,and the chest CT dynamic analysis of lesions showed wandering changes.The diagnosis was revised as"rheumatoid lung combined with acute exacerbation of chronic obstructive pulmonary disease,pulmonary heart disease".Finally,the clinical manifestations and imaging changes were both improved after methylprednisolone treatment.Ten rheumatoid arthritis patients with pneumothorax were selected in accordance with the literatures including three articles in Chinese and 49 articles in English.Among them,six patients had spontaneous pneumothorax due to rheumatoid nodules near the pleura ruptured into the chest cavity,three patients had spontaneous pneumothorax due to long-term medication for rheumatoid arthritis,only one patient had spontaneous pneumothorax before joint symptoms,two patients had bronchopleural fistula in addition to pneumothorax.Conc

关 键 词：关节炎 类风湿 液气胸 无关节症状 

分 类 号：R593.22[医药卫生—内科学]