类风湿关节炎相关间质性肺病患者临床特征及血清KL-6检测的意义

发布时间：2018-04-24 05:40

本文选题：类风湿关节炎 + 间质性肺病　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:探讨RA-ILD患者的临床特点及血清KL-6检测在RA-ILD中的意义。方法:回顾性分析2015年4月-2017年1月我院住院治疗的RA患者的临床资料。根据胸部HRCT结果分为RA-ILD组和RA-non-ILD组,所有患者均行胸部HRCT,健康对照组,CLIA法检测血清KL-6水平.采用独立样本T检验比较各组间血清KL-6水平差异,采用独立样本T检验或方差分析比较RA-ILD组及RA-non-ILD组临床、实验室结果差异,采用直线相关分析将RA-ILD组血清KL-6水平与临床指标的进行相关性分析。结果:1.RA-ILD患者临床结果(1)一般情况:81例RA患者中,男22例、女59例,年龄30~80岁。其中RA-ILD组患者39例,男13例,女26例,年龄44~80岁,平均(62±7.8)岁,病程0.2~30年、平均(7.66±7.64)年。(2)RA-ILD组患者临床表现:RA-ILD患者中合并呼吸系统症状者仅占少数,且症状轻微。39例患者呼吸系统症状按比例从高到底分别为:干咳3例(7.7%)、活动后胸闷气短2例(5.1%)、VelcroUp音2例(5.1%)。(3)RA-ILD组患者影像学结果(1)RA-ILD组影像学改变:RA-ILD组患者胸部HRCT改变依次为小叶间隔增厚24例(61.5%)、纤维条索影23例(59%)、磨玻璃影19例(48.7%)、斑片渗出/实变影7例(17.9%)、牵拉性支气管扩张7例(17.9%)、网格影6例(15.4%)、蜂窝影2例(5.1%)、胸膜下线影1例(2.6%)。(2)RA-ILD组影像分型结果:UIP型7例(17.95%),NSIP型13例(33.33%),未定型19例(48.72%)。(3)RA-ILD组影像学分级结果:I级37例(94.9%),II级2例(5.1%)2.RA-ILD组与RA-non-ILD组比较结果(1).临床基本情况比较:RA-ILD组患者年龄高于RA-non-ILD组(P0.05)(2)实验室指标比较:两组在WBC、LDH、ESR、CRP、免疫球蛋白、补体、RF滴度、抗CCP抗体水平上无统计学差异(P0.05)(3)肿瘤标记物比较:RA-ILD组患者CA19-9水平高于RA-non-ILD组(P0.05)(4)血清KL-6比较结果:RA-ILD组患者的血清KL-6(U/ml)水平为(269.72±210.24),高于RA-non-ILD组血清KL-6水平(76.93±80.32)和健康对照组(99.23±35.80),且差异有统计学意义(P0.05)。3.RA-ILD组患者血清KL-6水平与临床指标的相关性(1)临床基本情况:血清KL-6与年龄、发病年龄、病程、关节肿胀数及压痛数均无相关性(P0.05)(2)实验室指标:血清KL-6水平与LDH呈正相关(r=0.756,P0.05),与PLT、补体C3呈负相关(r分别为-0.342、-0.497,P0.05)。(3)肿瘤标记物:血清KL-6水平与Fer呈正相关(r=0.629,P0.01)结论:1.RA-ILD患者呼吸系统表现不典型,症状隐匿,需及早完善胸部HRCT检查。2.年龄、CA19-9升高与RA-ILD的发生密切相关。3..血清KL-6水平可作为RA-ILD诊断的血清学指标之一。
[Abstract]:Objective: to investigate the clinical features of RA-ILD patients and the significance of serum KL-6 detection in RA-ILD. Methods: the clinical data of RA patients hospitalized in our hospital from April 2015 to January 2017 were analyzed retrospectively. According to the results of chest HRCT, all patients were divided into RA-ILD group and RA-non-ILD group. The serum KL-6 levels were compared by independent sample T test, and the clinical and laboratory results of RA-ILD group and RA-non-ILD group were compared by independent sample T test or ANOVA. Linear correlation analysis was used to analyze the correlation between serum KL-6 level and clinical indexes in RA-ILD group. Results 1. The clinical results of RA-ILD patients were as follows: 1) of 81 patients with RA, 22 were males and 59 were females, aged 30 to 80 years. There were 39 patients in RA-ILD group, 13 males and 26 females, aged 4480 years, with an average age of 62 卤7.8 years. The course of disease was 0.2-30 years (mean 7.66 卤7.64) years. The respiratory symptoms of 39 patients with mild symptoms were as follows: dry cough, 3 cases, 7. 7%, chest tightness, shortness of breath, 2 cases, 5. 1% VelcroUp, 2 cases, 5. 1%, 2 cases, 5. 1%, 1% RA-ILD group, 2 cases, 1% RA-ILD group, 2 cases, 1% RA-ILD group. 24 cases with thickening of interlobular septum, 23 cases with fibrous cord shadow, 19 cases with grinding glass shadow and 48.7%, 7 cases with macular exudation / solid shadow, 7 cases with tractive bronchiectasis, 7 cases with tractive bronchiectasis, 6 cases with reticular shadow, 5 cases with honeycomb, 2 cases with honeycombing, 1 case with subpleural shadow, 1 case with subpleural line shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow, 1 case with subpleural shadow and 1 case with subpleural shadow. The results of imaging classification were as follows: 7 cases of UIP type (17. 95%) and 13 cases of NSIP type (13 cases) were divided into 3. 33 degrees, 19 cases of which were not finalized. The results of imaging grading in the group of 37 cases with grade I of 7 cases with grade 2 of grade 2 with grade 2 of grade 2 of grade 2 with that of the group of RA-non-ILD were compared with that of the group of RA-non-ILD. Comparison of the basic clinical conditions: the age of the patients in the 10% RA-ILD group was higher than that in the RA-non-ILD group (P 0.05). The laboratory indexes were as follows: the titer of CRP, immunoglobulin and complement RF in the two groups were higher than that in the RA-non-ILD group. There was no significant difference in the level of anti CCP antibody (P0.05T3) comparison of tumor markers: the CA19-9 level of the patients in the W RA-ILD group was higher than that in the RA-non-ILD group (P0.05 + 4). The results of serum KL-6 comparison showed that the serum KL-6 UP / ml level of the patients in the 10% RA-ILD group was 269.72 卤210.24, which was higher than that in the RA-non-ILD group (76.93 卤80.32) and the healthy control group (99.23 卤35.80), and the level of serum KL-6U / ml was higher than that in the RA-non-ILD group (76.93 卤80.32). The correlation between serum KL-6 level and clinical indexes in RA-ILD group (1) basic clinical information: serum KL-6 and age. Age of onset, course of disease, There was no correlation between the number of joint swelling and tenderness (P0.05 / 2) Laboratory index: serum KL-6 level was positively correlated with LDH (0.756U P0.05A), and negatively correlated with LDH and C3 (r = -0.342- 0.497n P0.05n. 3) tumor marker: serum KL-6 level was positively correlated with Fer (0.629 / P0.01). Conclusion: 1.RA-ILD patients have a negative correlation. The respiratory system is not typical. The symptom is concealed, the chest HRCT examination should be improved as soon as possible. 2. The increase of age CA19-9 was closely related to the occurrence of RA-ILD. Serum KL-6 level can be used as one of the serological markers for the diagnosis of RA-ILD.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22;R563

【参考文献】