类风湿关节炎合并肺间质病变的影响因素研究

发布时间：2018-11-13 17:59

【摘要】：目的探讨类风湿关节炎(RA)合并肺间质病变(ILD)的影响因素。方法选取2013年6月—2016年2月在江西省人民医院风湿免疫科住院治疗的RA患者349例,根据高分辨率CT(HRCT)检查结果分为RA组和RA合并ILD组(RA-ILD组)。记录并比较两组患者的一般资料、相关实验室检测指标及肺功能指标。结果 349例RA患者中,合并ILD 69例(19.8%)。RA-ILD患者的主要呼吸道症状为活动后干咳及呼吸困难,主要HRCT异常表现为毛玻璃样改变、网状结节状阴影。RA-ILD组患者男性比例、平均年龄、吸烟率、类风湿关节炎活动度评分(DAS28)高于RA组,差异有统计学意义(P0.05);两组患者病程比较,差异无统计学意义(P0.05)。RA-ILD组患者类风湿因子(RF)、抗环瓜氨酸肽抗体(抗-CCP抗体)、葡萄糖-6-磷酸异构酶(GPI)高于RA组,差异有统计学意义(P0.05);两组患者红细胞沉降率(ESR)、C反应蛋白(CRP)、纤维蛋白原、D-二聚体、免疫球蛋白G(Ig G)、免疫球蛋白A(Ig A)、免疫球蛋白M(Ig M)比较,差异无统计学意义(P0.05)。共68例患者进行了肺功能检查,RA-ILD组患者一氧化碳弥散量(DLCO)、肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气末容积(FEV1)低于RA组,通气功能障碍发生率、弥散功能减退发生率高于RA组,差异有统计学意义(P0.05);两组患者第1秒用力呼气末容积与用力肺活量比值(FEV1/FVC)、小气道功能障碍发生率比较,差异无统计学意义(P0.05)。多因素Logistic回归分析结果显示,年龄、DAS28、GPI是RA合并ILD的影响因素(P0.05)。Pearson相关分析结果显示,DLCO与年龄、DAS28、GPI均无线性相关关系(P0.05)。结论 ILD是RA患者的常见合并症,高龄、高疾病活动度、高滴度GPI是其危险因素。早期行HRCT检查有助于疾病的及早诊断和治疗,肺功能DLCO测定也对早期诊断ILD有一定参考价值。
[Abstract]:Objective to investigate the influencing factors of (ILD) in rheumatoid arthritis (RA) complicated with pulmonary interstitial disease. Methods 349 RA patients were selected from June 2013 to February 2016 in rheumatic immunology department of Jiangxi Provincial people's Hospital. According to the results of high resolution CT (HRCT), they were divided into RA group and RA combined with ILD group (RA-ILD group). To record and compare the general data of the two groups, related laboratory indicators and pulmonary function indicators. Results 69 cases (19.8%) of RA were complicated with ILD. The main respiratory symptoms of RA-ILD patients were dry cough and dyspnea after movement, and the main HRCT abnormalities were glass-like changes. The ratio of male, average age, smoking rate, rheumatoid arthritis activity score (DAS28) in RA-ILD group were significantly higher than those in RA group (P0.05). There was no significant difference in the course of disease between the two groups (P0.05). In RA-ILD group, rheumatoid factor (RF), anti-cyclic citrulline peptide antibody (anti-CCP antibody), glucose-6-phosphate isomerase (GPI) were higher than RA group. The difference was statistically significant (P0.05). Erythrocyte sedimentation rate, (ESR), C reactive protein (CRP), fibrinogen, D-dimer, immunoglobulin G (Ig G), immunoglobulin A (Ig A), immunoglobulin M (Ig M) were compared between the two groups. The difference was not statistically significant (P0.05). Pulmonary function tests were performed in 68 patients. In RA-ILD group, the forced end-expiratory volume (FEV1) of (VC), forced vital capacity (FVC),) in the first second was lower than that in the RA group, and the incidence of ventilatory dysfunction was lower in the RA-ILD group than in the RA group. The incidence of diffusive dysfunction was higher in RA group than in RA group (P0.05). There was no significant difference in the ratio of forced expiratory volume to forced vital capacity (FEV1/FVC) and the incidence of small airway dysfunction between the two groups in the first second (P0.05). The results of multivariate Logistic regression analysis showed that age and DAS28,GPI were the influencing factors of RA combined with ILD (P0.05). Pearson correlation analysis showed that there was no linear correlation between DLCO and age and DAS28,GPI (P0.05). Conclusion ILD is a common complication in patients with RA. Advanced age, high disease activity and high titer of GPI are the risk factors. Early HRCT examination is helpful to the early diagnosis and treatment of disease, and the determination of lung function DLCO is valuable for early diagnosis of ILD.
【作者单位】：江西省人民医院风湿免疫科;
【分类号】：R593.22;R563

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