类风湿关节炎相关肺间质病变患者的危险因素分析  

Risk factors analysis of patients with rheumatoid arthritis associated interstitial lung disease

作　　者：刘宏艳 魏华 臧银善 胡怀霞[4] 高瑛瑛[5] 何宏军[1] LIU Hongyan;WEI Hua;ZANG Yinshan;HU Huaixia;GAO Yingying;HE Hongjun(Department of Rheumatology and Immunology,Taixing People's Hospital,Taizhou,Jiangsu,225400,China;Department of Rheumatology and Immunology,Subei People's Hospital,Yangzhou,Jiangsu,225001,China;Department of Rheumatology and Immunology,Suqian First People'sHospital,Suqian,Jiangsu,223812,China;Department of Rheumatology and Immunology,Lianyungang second People's Hospital,Lianyungang,Jiangsu,222002,China;Department of Rheumatology and Immunology,Nantong First People's Hospital,Nantong,Jiangsu,226006,China)

机构地区：[1]泰兴市人民医院风湿免疫科,江苏泰州225400 [2]苏北人民医院风湿免疫科,江苏扬州225001 [3]宿迁市第一人民医院风湿免疫科,江苏宿迁223812 [4]连云港市第二人民医院风湿免疫科,江苏连云港222002 [5]南通市第一人民医院风湿免疫科,江苏南通226006

出　　处：《当代医学》2024年第1期27-31,共5页Contemporary Medicine

摘　　要：目的探讨类风湿关节炎(RA)患者发生肺间质病变(ILD)的危险因素。方法回顾性分析2018年1月至2020年10月江苏省5家综合性医院(泰兴市人民医院、苏北人民医院、连云港市第二人民医院、宿迁市第一人民医院、南通市第一人民医院)风湿免疫科收治的635例RA患者的临床资料,根据胸部有无ILD分成RA-ILD组(n=120)与RA-NILD组(n=515)。比较两组临床资料、血常规、肿瘤标志物、RA相关抗体及疾病活动度相关指标,探讨RA患者发生ILD的危险因素。结果635例RA患者中有120例合并ILD,发生率为18.90%。RA-ILD组年龄及癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、抗环瓜氨酸肽(ACCP)、C反应蛋白(CRP)水平均高于RA-NILD组,差异有统计学意义(P<0.05);两组性别、病程、吸烟史、血小板(PLT)、中性粒细胞/淋巴细胞(NLR)、单核细胞/淋巴细胞(MLR)、血小板/淋巴细胞(PLR)、甲胎蛋白(AFP)水平、类风湿因子(RF)水平、红细胞沉降率(ESR)、关节压痛数(TJC)、关节肿胀数(SJC)、28个关节疾病活动评分-红细胞沉降率(DAS28-ESR)、28个关节疾病活动评分-C反应蛋白(DAS28-CRP)比较差异无统计学意义。二元Logistic回归分析结果显示,高龄(OR=1.033,95%CI:1.014~1.053,P=0.001)和CA19-9升高(OR=1.027,95%CI:1.010~1.045,P=0.002)是RA-ILD的独立危险因素(P<0.05)。结论在RA中约有18.90%的患者发生ILD,年龄、CEA、CA125、CA19-9、ACCP、CRP升高均会增加RA发生ILD的风险,尤其对于高龄或CA19-9升高的RA患者应高度警惕ILD的发生,尽早完善肺部高分辨率计算机断层扫描(HRCT)检查,以便早期诊断与治疗,从而改善预后。Objective To study the risk factors for rheumatoid arthritis(RA)associated interstitial lung disease(ILD).Methods The clinical data of 635 RA patients admitted to department of the Rheumatology and Immunology five general hospitals in Jiangsu Province from January 2018 to October 2020(Taixing People's Hospital,Subei People's Hospital,Lianyungang Second People's Hospital,Suqian First People's Hospital,Nantong First People's Hospital)were retrospectively analyzed.They were divided into the RA-ILD group(n=120)and the RA-NILD group(n=515)accord-ing to the presence or absence of chest ILD.The clinical data,blood routine,tumor markers,RA-related antibodies and disease activity were com-pared between the two groups to explore the risk factors of ILD in patients with RA.Results ILD was found in 120(18.90%)of 635 RA patients.The age and levels of carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 19-9(CA19-9),anti-cyclic citrul-lined peptide antibody(ACCP)and C-reactive protein(CRP)in the RA-NILD group were higher than those in the RA-NILD group,and the differenc-es were statistically significant(P<0.05).There were no significant differences in gender,disease course,smoking history,platelets(PLT),neutro-phils/lymphocytes(NLR),monocytes/lymphocytes(MLR),platelets/lymphocytes(PLR),alpha-fetoprotein(AFP),rheumatoid factor(RF),eryth-rocyte sedimentation rate(ESR),tenderjoint count(TJC),swollen joint count(SJC),28 joint disease activity scores erythrocyte sedimentation rate(DAS28-ESR)and 28 joint disease activity scores-C-reactive protein(DAS28-CRP)between the two groups.Binary Logistic regression analysis showed that older age(OR=1.033,95%CI:1.014-1.053,P=0.001)and CA19-9 increased(OR=1.027,95%CI:1.010-1.045,P=0.002)were indepen-dent risk factor for RA-ILD(P<0.05).Conclusion About 18.90%of RA patients have ILD,age,CEA,CA125,CA19-9,ACCP,CRP increased will increase the risk of ILD,especially for RA patients with advanced age or CA19-9 increased should be highly alert to the occurrence of ILD,impr

关 键 词：类风湿关节炎 间质性肺病 危险因素 

分 类 号：R593.22[医药卫生—内科学]