类风湿关节炎相关肺间质病变的危险因素、临床和影像学特点

目的分析类风湿关节炎(RA)相关肺间质病变(RA-ILD)的危险因素、临床特点及影像学特征,以利于早期诊断、合理治疗。方法回顾性总结233例住院诊治RA患者的临床资料,比较RA-ILD组与单纯RA组的临床特点。结果 RA-ILD的发生率为20.6%(48/233)。RA-ILD组患者平均发病年龄、平均病程、大量吸烟率、类风湿因子水平、抗环瓜氨酸肽抗体阳性率、抗核周因子阳性率和抗角质蛋白抗体阳性率均高于单纯RA组,差异有统计学意义(P<0.05);双手X线Ⅰ期改变百分数较单纯RA组低,差异有统计学意义(P<0.05)。26例(54.17%)RA-ILD患者有呼吸系统临床表现,包括咳嗽、活动后呼吸困难和肺部爆裂音;22例(45.83%)通过肺高分辨CT(HRCT)和/或肺功能(PFT)检查诊断。HRCT改变依次为纤维条索/网格影33例(68.75%)、斑片渗出影/实变影21例(43.75%)、磨玻璃影15例(31.25%)、蜂窝状影11例(22.92%)以及胸腔积液5例(10.42%);PFT均有弥散功能减退。结论 RA-ILD发病年龄较大、病程较长,与疾病严重性相平行,而与疾病活动性不相关。HRCT及PFT对早期诊治RA-ILD有重要价值。

Risk Factors, Clinical and Radiographic Characteristics of Rheumatoid Arthritis Associated Interstitial Lung Disease

Objective Interstitial lung disease （ILD） has been recognized as an important complication of rheumatoid arthritis （RA）. We undertook current study to assess the incidence, predictors, clinical and radiographic features of RA-associated ILD. Methods We compared the clinical data of RA patients with and without ILD （RA-ILD） retrospectively, the incidence and predictors of ILD were investigated and the clinical and radiographic characteristics of patients with RA-ILD were studied. Results Out of 233 patients, 48 developed RA-ILD, with the prevalence of 20. 6% and among which 22 （45.83%） patients were asymptomatic. The incidence of RA-ILD was associated with older age at the time of disease onset, longer disease duration, smoking, higher level of serum rheumatoid factor （RF）, increased frequency of anti-citrullinated peptide/protein antibodies （ACPA） （including anti-cyclic citrullinated peptide, anti- perinuclear factor, and anti-keratin antibody） （ all P 〈 0. 05 ）. RA-ILD manifested as cough, progressive exertional dyspnea, and cracles at both lung fields clinically. The findings on high-resolution computed tomography （ HRCT ） were fiberotic lines/reticulation （ 68.75%, 33/48 ）, exudative infiltration/ consolidation （21/48, 43.75% ）, ground glass opacities （ 15/48, 31.25% ）, honeycombing （ 11/48, 22.92% ）, and pleural effusion （5/48, 10.42% ）. Pulmonary function tests （PFq＇） were done in 37 patients with RA-ILD and 75.68% of these patients were abnormal. DLCO （diffusion capacity for carbon monoxide of the lung） was decreased in all 28 patients, complicated with restrictive ventilation impairment in 7 patients, and 4 patients with mixed ventilation disturbance. Conclusions RA-ILD is an important feature of RA. It is related with age, course of disease, smoking, serum level of rheumatoid factor, positive ACPA, and disease severity. RA-ILD is not related to disease activity. HRCT and PFT are valuable examinations for early diagnosis and appropriated therapy of RA-ILD.