系统性硬化病肺间质病变临床分析  

Clinical analysis of interstitial lung disease in systemic sclerosis

作　　者：王蕾 郗艳 孔祥贞 屠文震 舒政 陈园园 孙大燕 何东仪 Wang Lei;Xi Yan;Kong Xiangzhen;Tu Wenzhen;Shu Zheng;Chen Yuanyuan;Sun Dayan;He Dongyi(Department of Rheumatology,Shnaghai TCM-Intergrated Hospital,Shanghai University of TCM,Shanghai 200082,China;Departmen of Radiology,Shnaghai TCM-Intergrated Hospital,Shanghai University of TCM,Shanghai 200082,China;School of Life Sciences,Fudan University Shanghai 2000438,China;Department of Neonatal Surgery,Beijing Children Hospital,Capital Medical University Beijing 100045,China;Department of Arthrology Guanghua Hospital,Shanghai University of TCM,Shanghai 200052,China)

机构地区：[1]上海中医药大学附属上海市中西医结合医院风湿病科,上海200082 [2]上海中医药大学附属上海市中西医结合医院放射科,上海200082 [3]复旦大学生命科学院,上海200438 [4]首都医科大学附属北京儿童医院新生儿外科,北京100045 [5]上海中医药大学附属光华医院关节内科,上海200052

出　　处：《中华风湿病学杂志》2024年第4期237-243,共7页Chinese Journal of Rheumatology

基　　金：上海市虹口区卫生健康委员会医学科研课题(2023-2025);上海中医药大学附属医院"临床研究型骨干人才培养计划"(2023LCRC22)。

摘　　要：目的回顾性分析202例系统性硬化病(SSc)合并肺间质病变(ILD)患者的疾病特点,研究不同分型SSc-ILD的特征及其与血管病变及抗体的相关性,加强对SSc-ILD的疾病认识。方法收集2021年5月至2022年9月在上海市中西医结合医院住院的249例SSc患者的病例资料,分别通过SSc-ILD与SSc非ILD 2组间比较以及SSc-ILD组内不同分型之间的比较,分析SSc-ILD的疾病特点,及其与血管病变、自身抗体之间的相关性。统计分析方法根据数据类型,分别采用配对t检验、Wilcoxon符号秩和检验或χ^(2)检验。结果本研究中202例SSc-ILD患者中女性患者183例(90.6%),47例SSc非ILD患者中女性患者36例(76.6%),女性SSc患者出现ILD的发生率明显高于男性(χ^(2)=7.05,P=0.008)。胸部高分辨率CT(HRCT)发现磨玻璃影最常见(90.1%);小叶内间隔增厚、网状影的发生率均高达70.0%以上;其次是小叶间隔增厚、支气管牵拉,发生率均高于50.0%。普遍型间质性肺炎(UIP)组肺纤维化积分[23.77(10.69,36.54)]高于非特异性间质性肺炎(NSIP)组[12.63(3.44,17.89),Z=5.19,P<0.001];NSIP(纤维化型)(f-NSIP)组肺纤维化积分[18.55(6.52,26.06)]高于NSIP(细胞型)(c-NSIP)组[5.27(1.15,7.55),Z=7.59,P<0.001];肺纤维化积分与SSc发病年龄呈正相关(r=0.02,P=0.021)。UIP患者病程中伴发毛细血管扩张(37.5%与19.9%,χ^(2)=2.60,P=0.009)、皮肤溃疡(48.2%与31.5%,χ^(2)=2.21,P=0.027)及指骨吸收(51.8%与28.1%,χ^(2)=3.17,P=0.002)的发生率高于NSIP;f-NSIP组病程中出现毛细血管扩张(27.2%与10.8%,χ^(2)=2.26,P=0.024)与指骨吸收(35.8%与18.5%,χ^(2)=2.32,P=0.021)的发生率高于c-NSIP组。SSc-ILD患者的抗Scl-70抗体阳性率(76.2%与23.4%)明显高于SSc非ILD组患者(χ^(2)=47.61,P<0.001);而SSc非ILD组患者的抗着丝点抗体阳性率(31.9%与11.4%)明显高于SSc-ILD组患者(χ^(2)=12.42,P=0.001)。SSc-ILD组患者的抗SSB抗体阳性率(9.9%与0)具有显著性差异(P=0.025)。结论抗Scl-70抗体阳性与SSc-ILD�Objective Retrospective analyzed the characteristics of 202 patients with interstitial lung disease(ILD)in systemic sclerosis(SSc),studied the relationship between their characteristics in different types of SSc-ILD and vascular disease and antibody,in order to increase the understanding of SSc-ILD.Methods A total of 249 inpatients with SSc in our hospital from May 2021 to September 2022 were invloved.By comparing SSC-ILD with SSc-non-ILD groups and different types in SSc-ILD groups,to analyze the relationship between their characteristics of SSc-ILD and vascular disease and auto-antibody.According to the data type,the paired sample t test,Wilcoxon signed rank sum test,ANOVA analysis of variance or Chi-square test were used for statistical analysis.The statistical analysis software to analyze the relationship between their characteristics of SSc-ILD and vascular disease and auto-antibody.According to the data type,the paired sample t test,Wilcoxon signed rank sum test,or Chi-square test were used for statistical analysis.Results In this study,among 202 patients with SSC-ILD,183 were female(90.6%),and among 47 patients with SSc-non-ILD,36 were female(76.6%).The incidence of ILD in female SSc patients was significantly higher than that in male patients(χ^(2)=7.05,P=0.008).The chest high-resolution CT(HRCT)showed that ground glass was the most common presentation(90.1%).The incidence of interlobular septum thickening and reticular shadow were more than 70.0%.The incidence of interlobular thickening and bronchial distraction was higher than 50.0%.The pulmonary fibrosis score[23.77(10.69,36.54)]in the usual interstitial pneumonia(UIP)group was higher than that in the nonspecific interstitial pneumonia(NSIP)group[12.63(3.44,17.89)](Z=5.19,P<0.001).The pulmonary fibrosis score[18.55(6.52,26.06)]in the nonspecific interstitial pneumonia(the fibrotic type)(f-NSIP)group was higher than that in the nonspecific interstitial pneumonia(cellular type)(c-NSIP)group[5.27(1.15,7.55),Z=7.59,P<0.001].The score of pulmonary fibrosis

关 键 词：硬化病 系统性 肺炎纤维化 普遍型间质性肺炎 非特异性间质性肺炎 自身抗体 

分 类 号：R593.25[医药卫生—内科学] R563[医药卫生—临床医学]