干燥综合征合并肺间质病变住院患者临床诊疗特点研究  

Clinical Characteristics of Inpatients with Sj gren′s Syndrome-interstitial Lung Disease

作　　者：郭子琳 周新尧[1] 唐晓颇[1] GUO Zilin;ZHOU Xinyao;TANG Xiaopo(Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《世界中医药》2024年第19期2993-3003,3007,共12页World Chinese Medicine

基　　金：中央级公益性科研院所基本科研业务费专项(ZZ15-YQ-023);中国中医科学院科技创新工程项目(CI2021A01510,CI2021A01502);中国中医科学院自主选题项目(ZZ11-029,ZZ15-XY-PT-11)。

摘　　要：目的:挖掘干燥综合征合并肺间质病变(SS-ILD)与未合并肺间质病变(SS-NILD)住院患者之间的临床差异,为SS-ILD的早期诊断及后续临床治疗提供客观理论支持。方法:收集符合标准的SS-ILD和SS-NILD住院患者的临床资料,对基本信息、临床表现、证型舌脉、实验室检查、治疗方案等进行统计分析。结果:共纳入299例患者,其中SS-ILD组87例,SS-NILD组212例。SS-ILD组年龄、有烟酒史、有呼吸系统症状、舌苔无或剥脱、脉象弱的概率较高,氧分压水平较低,红细胞沉降率、C反应蛋白水平及类风湿因子阳性率较高;辨证为阴虚津亏、气阴两虚、燥瘀互结的患者合并ILD的比例较高(P<0.05)。回归分析结果表明:合并ILD与吸烟史、主诉咳嗽、舌苔无或剥脱、弱脉及气阴两虚证呈正相关,与主诉眼干呈负相关。SS-ILD肺功能检查以轻度阻塞性/限制性通气功能障碍和轻度弥散功能障碍为主,胸部高分辨CT主要表现为胸膜增厚、结节影、磨玻璃影。SS-ILD所用中成药以虫草类制剂为主,SS-NILD以雷公藤类制剂为主;西医用药以免疫抑制剂为主,或与中效糖皮质激素联合应用。结论:SS住院患者多为高龄中老年女性,有吸烟史及呼吸系统症状、中医辨证为气阴两虚是合并ILD的相关因素,临床用药以抗炎、调节免疫为目标,生物制剂仍需进一步推广应用。Objective:To explore the clinical differences between inpatients with Sj gren′s syndrome and interstitial lung disease(SS-ILD)and those without interstitial lung disease(SS-NILD),providing objective theoretical support for the early diagnosis and subsequent clinical treatment of SS-ILD.Methods:Clinical data from inpatients with SS-ILD and SS-NILD meeting the inclusion criteria were collected.Statistical analysis was conducted on basic information,clinical manifestations,syndrome types based on tongue and pulse diagnosis,laboratory tests,and treatment regimens.Results:A total of 299 patients were included,with 87 in the SS-ILD group and 212 in the SS-NILD group.The SS-ILD group had a higher probability of being older,having a history of smoking and alcohol use,experiencing respiratory symptoms,having no or desquamated tongue coating,and having weak pulses.This group also had lower oxygen partial pressure,higher erythrocyte sedimentation rate,C-reactive protein levels,and rheumatoid factor positivity rates.Patients diagnosed with the syndromes of yin deficiency with fluid depletion,qi and yin deficiency,and dryness in combination with stasis had a higher likelihood of ILD(P<0.05).Regression analysis indicated that ILD was positively correlated with smoking history,cough as the primary complaint,no or desquamated tongue coating,weak pulse,and qi-yin deficiency syndrome,and negatively correlated with dry eye as the primary complaint.Pulmonary function tests in the SS-ILD group mainly showed mild obstructive/restrictive ventilatory dysfunction and mild diffusion dysfunction.High-resolution chest CT in SS-ILD patients primarily showed pleural thickening,nodular shadows,and ground-glass opacities.The main Chinese patent medicines used in the SS-ILD group were formulas containing Cordyceps,while the SS-NILD group predominantly used Tripterygium wilfordii-based preparations.Western medicine treatments were mainly immunosuppressants,or a combination of intermediate-acting glucocorticoids.Conclusion:Hospitalized SS patien

关 键 词：干燥综合征 肺间质病变 住院患者 临床特点 治疗方案 中医舌脉 中医证型 回顾性研究 

分 类 号：R259[医药卫生—中西医结合]