系统性硬化患者间质性肺病发生及进展的影响因素分析  

Influencing factors for occurrence and progression of interstitial lung disease in patients with systemic sclerosis

作　　者：刘娟 张瑾[1] 俞秋霞 刘冰冰 刘伟丽[1] 王晓东[1] 丁健[1] LIU Juan;ZHANG Jin;YU Qiuxia;LIU Bingbing;LIU Weili;WANG Xiaodong;DING Jian(Department of Rheumatology and Immunology,Ningbo Medical Center Lihuili Hospital(Lihuili Hospital Affiliated to Ningbo University),Ningbo 315040,China)

机构地区：[1]宁波市医疗中心李惠利医院(宁波大学附属李惠利医院)风湿免疫科,315040

出　　处：《浙江医学》2024年第17期1830-1834,1839,共6页Zhejiang Medical Journal

摘　　要：目的探讨系统性硬化(SSc)发生间质性肺病(ILD)以及出现进展性肺纤维化(PPF)的临床特点和影响因素。方法回顾性收集2017年1月至2021年12月宁波市医疗中心李惠利医院风湿科门诊收治的75例SSc患者为研究对象。根据是否合并ILD,将患者分为SSc合并ILD(SSc-ILD)组41例和SSc未合并ILD(SSc-nILD)组34例。采用单因素和多因素logistic回归分析SSc患者发生ILD的影响因素。采用单因素logistic回归分析SSc-ILD进展为PPF的影响因素。以肺部高分辨率CT诊断ILD为观察起点,出现PPF为观察终点,绘制Kaplan-Meier生存曲线,采用log-rank检验比较抗Scl-70抗体(ATA)阳性组和ATA阴性组患者发生PPF的中位时间。结果SSc-ILD组患者病程长于SSc-nILD组,弥漫型SSc比例、指/趾端溃疡和(或)凹陷性瘢痕、胃食管反流、肺动脉高压发生率、修订Rodnan评分、ATA阳性率均高于SSc-nILD组,抗着丝点抗体(ACA)阳性率低于SScnILD组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析发现,病程长是SSc患者发生ILD的独立危险因素(OR=1.017,95%CI:1.005~1.029,P=0.005),而ACA是SSc患者发生ILD的独立保护因素(OR=0.102,95%CI:0.017~0.621,P=0.013)。41例SSc-ILD患者中,进展为PPF(PPF组)11例,未进展为PPF(nPPF组)30例。PPF组和nPPF组患者ATA阳性率比较,差异有统计学意义(P<0.05)。单因素logistic回归分析发现ATA阳性是SSc-ILD进展为PPF的危险因素(OR=5.330,95%CI:1.156~24.598,P=0.032)。将PPF患者进一步分为ATA阳性组8例和ATA阴性组3例,进行生存分析,结果显示ATA阳性组患者发生PPF的中位时间为12.0(95%CI:6.8~17.2)个月,明显短于ATA阴性组的48.0(95%CI:37.5~58.5)个月,两组比较差异有统计学意义(P=0.033)。结论长病程可以作为SSc发生ILD的影响因素,而ATA阳性可以作为SSc-ILD患者出现PPF的影响因素。Objective To investigate the clinical characteristics and influencing factors of interstitial lung disease(ILD)and progressive pulmonary fibrosis(PPF)in patients with systemic sclerosis(SSc).Methods Seventy-five patients with SSc in the Department of Rheumatology of Ningbo Medical Center Lihuili Hospital from January 2017 to December 2021 were collected.Among them,41 patients with SSc complicated with ILD(SSC-ILD group)and 34 patients without ILD(SSC nILD group).The independent risk factors for ILD in SSc patients were analyzed by univariate and multivariate logistic regression analysis,while influencing factors for PPF were analyzed by univariate logistic regression.With high-resolution computed tomography diagnosis of ILD as the observation starting point and PPF as the observation end point,Kaplan-Meier survival curve was drawn,and the median time to develop PPF was compared between antitopoisomerase I antibodies(ATA)positive group and ATA negative group by log-rank test.Results The course of disease in the SSc-ILD group was longer than that of the SSc-nILD group,the proportion of dcSSc,the incidence of finger/phalangeal ulcer and/or depressed scar,gastroesophageal reflux,pulmonary hypertension,modified Rodnan Skin Score,and the positive rate of ATA in the SSC-ILD group were higher than those of the SSc-nILD group,while the positive rate of anticentromere antibodies(ACA)was lower than that of the SSc-nILD group,the differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that a long course of disease was an independent risk factor for ILD in SSc patients(OR=1.017,95%CI:1.005-1.029,P=0.005),while ACA positive was an independent protective factor for ILD of SSc patients(OR=0.102,95%CI:0.017-0.621,P=0.013).Among the 41 patients with SSc-ILD,11 cases progressed to PPF(PPF group)and 30 cases did not(nPPF group).There was a significant difference in the positive rate of ATA between PPF group and nPPF group(P<0.05).Univariate logistic regression analysis showed that ATA

关 键 词：系统性硬化 间质性肺病 进展性肺纤维化 临床特点 影响因素 

分 类 号：R593.2[医药卫生—内科学] R563[医药卫生—临床医学]