硬皮病相关间质性肺病与特发性肺纤维化的临床比较  

Clinical Comparison Between Scleroderma Associated Interstitial Lung Disease and Idiopathic Pulmonary Fibrosis

作　　者：陈英 周淑红[2] 王妍 梁刘娜 杨晓蓉 郭莉江 CHEN Ying;ZHOU Shu-hong;WANG Yan;LIANG Liu-na;YANG Xiao-rong;GUO Li-jiang(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China;Department of Ultrasound,Gansu Provincial Hospital,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]甘肃省人民医院免疫风湿科,甘肃兰州730000

出　　处：《医学信息》2023年第10期53-58,共6页Journal of Medical Information

基　　金：甘肃省自然科学基金项目(编号:21JR1RA035);甘肃省人民医院国家级科研项目(编号:19SYPYB-23)。

摘　　要：目的比较系统性硬化症相关肺间质性病变(SSc-ILD)与特发性肺纤维化(IPF)患者的临床特点。方法收集甘肃省人民医院2018年10月-2021年11月明确诊断为SSc-ILD和IPF患者资料,对其临床特点进行回顾性分析,并采用Praeson线性相关分析乳酸脱氢酶水平与DLCOpre%及HRCT评分的相关性,采用多因素线性回归分析影响患者肺纤维化程度的相关因素。结果共纳入68例患者,其中SSc-ILD患者28例,IPF患者40例,SSc-ILD组的发病年龄低于IPF组,差异有统计学意义(P<0.05);SSc-ILD组多为女性,皮肤关节症状为首发表现较多,IPF组吸烟及男性患者占比较多,呼吸系统症状出现时间长,以呼吸症状为首发表现,咳嗽、咳痰、气短、乳酸脱氢酶升高,DLCO%pre降低占比高于SSc-ILD组,差异有统计学意义(P<0.05);IPF组HRCT以UIP型多见,蜂窝状影、肺纤维化评分高于SSc-ILD组,差异有统计学意义(P<0.05);SSc-ILD组HRCT以NSIP多见,纤维条索影、心包积液患者多于IPF组,差异有统计学意义(P<0.05);Praeson线性相关分析显示,LDH水平与HRCT评分呈正相关(r=0.647,P<0.05),LDH水平与DLco%pre值呈负相关(r=-0.422,P<0.05);多因素线性回归分析显示,LDH水平是肺纤维化不良预后的独立危险因素(P<0.05)。结论SSc-ILD和IPF患者的临床特点存在显著差异,自身抗体、肺功能、HRCT在肺间质性疾病的诊断中发挥重要价值,乳酸脱氢水平与SSC-ILD患者肺纤维化严重程度高度相关,临床值得注意。Objective To compare the clinical characteristics of patients with systemic sclerosis-associated interstitial lung disease(SSc-ILD)and idiopathic pulmonary fibrosis(IPF).Methods The data of patients diagnosed with SSc-ILD and IPF in Gansu Provincial People's Hospital from October 2018 to November 2021 were collected,and their clinical characteristics were retrospectively analyzed.The correlation between lactate dehydrogenase level and DLCOpre%and HRCT score was analyzed by Praeson linear correlation.Multivariate linear regression analysis was used to analyze the related factors affecting the degree of pulmonary fibrosis in patients.Results A total of 68 patients were included,including 28 patients with SSc-ILD and 40 patients with IPF.The age of onset in the SSc-ILD group was lower than that in the IPF group,and the difference was statistically significant(P<0.05).The SSc-ILD group was mostly female,with more skin and joint symptoms as the first manifestation.In the IPF group,smoking and male patients accounted for more,respiratory symptoms appeared for a long time,with respiratory symptoms as the first manifestation,cough,sputum,shortness of breath,lactate dehydrogenase increased,DLCO%pre decreased higher than the SSc-ILD group,the difference was statistically significant(P<0.05);the HRCT of IPF group was more common in UIP type,and the scores of honeycomb shadow and pulmonary fibrosis were higher than those of SSc-ILD group(P<0.05).In SSc-ILD group,NSIP was more common in HRCT,and patients with fibrous cord shadow and pericardial effusion were more than those in IPF group,the difference was statistically significant(P<0.05).Praeson linear correlation analysis showed that LDH level was positively correlated with HRCT score(r=0.647,P<0.05),and LDH level was negatively correlated with DLCO%pre(r=-0.422,P<0.05).Multivariate linear regression analysis showed that LDH level was an independent risk factor for poor prognosis of pulmonary fibrosis(P<0.05).Conclusion There are significant differences in clinical characte

关 键 词：间质性肺疾病 系统性硬化症 特发性肺纤维化 

分 类 号：R744.51[医药卫生—神经病学与精神病学]