结缔组织病相关性间质性肺疾病的临床分析

发布时间：2018-12-25 07:53

【摘要】：目的:结缔组织病是临床常见的与自身免疫系统有关的疾病,可以累及多个系统及器官,肺脏因为含有丰富的结缔组织而容易受损。结缔组织病相关性间质性肺疾病(connective tissue disease associated with interstitial lung disease,CTD-ILD)是已知病因间质性肺疾病中比较常见的一类,晚期其死亡率比较高。本文通过总结CTD-ILD患者的临床表现、证候特点、实验室及影像学检查、治疗方法,使临床医师提高对本病的认识,以期做到早期诊断和治疗。方法:收集2013年1月~2015年8月于山东中医药大学附属医院肺病科住院的53例CTD-ILD患者的临床资料,对患者的证候特点、临床表现、实验室检查、胸部CT、肺功能、中医与西医治疗方法进行回顾性分析。结果:在53例CTD-ILD患者中,男11例,女42例,平均发病年龄为57.9±10.4岁,病程最长者8年。52例中医诊断为肺痿,1例诊断为喘证,中医证候诊断中23例诊为痰瘀阻肺证,占43.4%,5例诊为痰热蕴肺证,占9.4%,4例诊为痰瘀互结证,占7.6%,16例诊为肺肾亏虚证,占30.2%,5例诊为气阴两虚证,占9.4%。临床表现以咳嗽、胸闷憋喘、关节肿痛为主。12例SS-ILD患者中有10例抗Robert52抗体阳性,约占83.3%。胸部CT可表现为网格影、蜂窝肺、磨玻璃影、纤维条索影等,出现肺大泡者13例,其中9例为SS-ILD,占所有SS-ILD患者的75%。所有患者中有43例应用糖皮质激素治疗,占81.1%,2例应用细胞毒药物,40例应用其他免疫抑制剂。结论:CTD-ILD患者女性多于男性,患者可以结缔组织病的症状为首发表现,也可以呼吸道症状为首发表现,CTD-ILD患者最常见的表现为咳嗽、呼吸困难、关节肿痛。抗Robert52抗体在SS-ILD患者中的阳性率较高,对于D-二聚体升高的CTD-ILD患者,应适当予以抗凝治疗。胸部HRCT以网格影、蜂窝肺、磨玻璃影较常见,SS-ILD相对于其他CTD-ILD患者更易出现肺大泡。目前CTD-ILD的治疗仍以糖皮质激素、免疫抑制剂治疗为主,还可应用吡非尼酮及具有抗纤维化作用的中药治疗。CTD-ILD患者容易并发感染性疾病,应该积极给予抗感染治疗。
[Abstract]:Objective: connective tissue disease (CTD) is a common disease associated with autoimmune system. Connective tissue disease associated with interstitial lung disease (connective tissue disease associated with interstitial lung disease,CTD-ILD) is a common type of interstitial lung disease with high mortality in late stage. In this paper, the clinical manifestations, syndromes, laboratory and imaging examinations and treatment methods of CTD-ILD patients were summarized, so that the clinicians could improve their understanding of the disease in order to achieve early diagnosis and treatment. Methods: the clinical data of 53 patients with CTD-ILD were collected from January 2013 to August 2015 in the Department of Pulmonary Diseases, affiliated Hospital of Shandong University of traditional Chinese Medicine. The symptoms, clinical manifestations, laboratory examination and lung function of chest CT, were analyzed. The traditional Chinese medicine and western medicine treatment method carries on the retrospective analysis. Results: among the 53 patients with CTD-ILD, 11 were male and 42 were female. The average age of onset was 57.9 卤10.4 years old. The longest course of disease was 8 years. 52 cases were diagnosed as pulmonary impotence and 1 case as asthma syndrome. In the diagnosis of TCM syndrome, 23 cases were diagnosed as phlegm stasis syndrome, 5 cases as phlegm heat accumulation syndrome, 4 cases as phlegm stasis syndrome, 16 cases as deficiency of lung and kidney syndrome, 30.2 cases as syndrome of deficiency of lung and kidney, 4 cases as syndromes of phlegm and blood stasis, 16 cases as syndrome of deficiency of lung and kidney, and 3 cases as syndrome of accumulation of phlegm and blood stasis. Five cases were diagnosed as deficiency of qi and yin, accounting for 9.4%. The clinical manifestations were cough, chest choke, dyspnea, joint swelling and pain, and 10 of 12 SS-ILD patients were positive for anti Robert52 antibody, accounting for 83.3%. The chest CT could be shown as reticular shadow, honeycomb lung, glass-grinding shadow, fibrous cord shadow and so on. There were 13 cases of pulmonary bullae, of which 9 cases were SS-ILD, which accounted for 75% of all SS-ILD patients. 43 of all patients were treated with glucocorticoid, accounting for 81.1% of them were treated with cytotoxic drugs and 40 cases were treated with other immunosuppressants. Conclusion: the first symptom of connective tissue disease and respiratory tract symptom can be the first symptom in CTD-ILD patients. The most common manifestations of CTD-ILD patients are cough, dyspnea, joint swelling and pain. The positive rate of anti-Robert52 antibody was higher in SS-ILD patients. For CTD-ILD patients with elevated D-dimer, anticoagulant therapy should be given. The chest HRCT was more common with reticular shadow, honeycomb lung and glass opacity, and SS-ILD was more likely to develop pulmonary bullae than other CTD-ILD patients. At present, the main treatment of CTD-ILD is glucocorticoid, immunosuppressant therapy, and can also be treated with pifenidone and traditional Chinese medicine with anti-fibrosis effect. CTD-ILD patients are prone to complicated with infectious diseases, should be actively given anti-infective treatment.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563

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