隐原性与继发于结缔组织病的机化性肺炎的临床特征及预后对比分析

发布时间：2018-12-14 00:11

【摘要】：目的对比分析隐原性与继发于结缔组织病的机化性肺炎(OP)的临床特征及预后。方法采用回顾性研究,选取东南大学附属中大医院2006年2月—2012年1月期间37例经病理证实的OP住院患者,根据临床症状、肺功能检查、免疫学检查和胸部高分辨率CT(HRCT)扫描等结果,结合典型的OP组织病理表现,经有经验的呼吸科、风湿科、放射科及病理科医生会诊后,剔除5例病因为药物、放射性治疗或感染所致的OP患者,最终纳入32例作为研究对象,并将其分为隐原性机化性肺炎(COP)组(14例)及继发于结缔组织病机化性肺炎(CTD-OP)组(18例)。两组患者给予糖皮质激素治疗3~12个月,随访18个月。比较两组患者的临床症状、肺功能指标、动脉血气分析指标、影像学特征及预后情况。结果两组患者的年龄、呼吸困难发生率、氧合指数(PaO2/FiO2)及C反应蛋白(CRP)比较,差异均无统计学意义(P0.05);CTD-OP组的女性比例、类风湿因子(RF)阳性率、抗核抗体(ANA)阳性率均高于COP组(P0.05)。两组间第1秒用力呼气容积占预计值百分比(FEV1%)、用力肺活量占预计值百分比(FVC%)、肺总量占预计值百分比(TLC%)、残气量占预计值百分比(RV%)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)、一氧化碳弥散量占预计值百分比(DLCO%)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、肺泡-肺动脉氧分压差〔P(A-a)O2〕分别在治疗前和治疗后比较,差异均无统计学意义(P0.05)。组内比较显示,治疗前两组患者的FEV1%、FVC%、TLC%、RV%、FEV1/FVC、DLCO%、PaO2、P(A-a)O2与治疗后比较,差异均有统计学意义(P0.05)。两组的治疗方案比较,差异无统计学意义(P0.05)。两组患者经激素治疗后总有效率为93.8%(30/32);两组的预后情况比较,差异有统计学意义(u=-2.080,P=0.038);COP组的痊愈率(50.0%)高于CTD-OP组(16.7%),复发率(7.1%)低于CTD-OP组(38.9%),差异有统计学意义(χ2=4.17、4.20,P=0.04、0.03)。结论 COP与CTD-OP患者早期临床症状相似,表现为轻、中度限制性通气功能障碍及弥散功能异常,轻度低氧血症;激素治疗早期阶段有效率高,在后期的随访中发现CTD-OP患者较COP患者复发率高、痊愈率低,故对OP患者需要定期随访。
[Abstract]:Objective to compare the clinical features and prognosis of cryptogenic pneumonia with that secondary to connective tissue disease (OP). Methods A retrospective study was conducted in 37 patients with OP confirmed by pathology from February 2006 to January 2012 in the affiliated Chinese University Hospital of Southeast University. The pulmonary function was examined according to the clinical symptoms. The results of immunological examination and high resolution CT (HRCT) scan of chest, combined with typical histopathological manifestations of OP, were reviewed by experienced doctors in respiratory department, rheumatology department, radiology department and pathologist, and 5 cases of pathogeny were excluded as drugs. Thirty-two patients with OP caused by radiation therapy or infection were included in the study and were divided into two groups: (COP) group (n = 14) and CTD-OP group (n = 18). Patients in both groups were treated with glucocorticoid for 3-12 months and followed up for 18 months. The clinical symptoms, pulmonary function, arterial blood gas, imaging features and prognosis were compared between the two groups. Results there was no significant difference in age, incidence of dyspnea, oxygenation index (PaO2/FiO2) and C-reactive protein (CRP) between the two groups (P0.05). The percentage of women, the positive rate of rheumatoid factor (RF) and the positive rate of anti-nuclear antibody (ANA) in CTD-OP group were higher than those in COP group (P0.05). Forced expiratory volume (FEV1%), forced vital capacity (FVC%), total lung volume (TLC%), and residual volume (RV%) in the first second of the two groups were compared. Forced expiratory volume / forced vital capacity (FEV1/FVC), carbon monoxide diffusion as a percentage of predicted value (DLCO%), arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), (P (A-a) O 2) there was no significant difference before and after treatment (P0.05). Intragroup comparison showed that there were significant differences in FEV1%,FVC%,TLC%,RV%,FEV1/FVC,DLCO%,PaO2,P (A-a) O _ 2 between the two groups before and after treatment (P0.05). There was no significant difference between the two groups (P0.05). The total effective rate of the two groups was 93.8% (30 / 32) after hormone therapy, and the difference between the two groups was statistically significant (u-2.080). The recovery rate in COP group (50.0%) was higher than that in CTD-OP group (16.7%), and the recurrence rate (7.1%) was lower than that in CTD-OP group (38.9%). The difference was statistically significant (蠂 2 4.17 4.20 P 0.04 0. 03). Conclusion the early clinical symptoms of patients with COP and CTD-OP are similar, showing mild and moderate restrictive ventilation dysfunction and abnormal diffusion function, and mild hypoxemia. Hormone therapy in the early stage of the high effective rate, in the latter stage of follow-up found that the recurrence rate of CTD-OP patients than COP patients, the recovery rate is low, so OP patients need to be followed up regularly.
【作者单位】：东南大学附属中大医院呼吸内科;上海市浦东新区公利医院呼吸科;东南大学附属中大医院放射科;东南大学附属中大医院风湿免疫科;
【基金】：江苏省卫生厅面上科研课题(H201031)
【分类号】：R563.1

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