活动期类风湿关节炎患者肺功能变化相关性研究

目的研究活动期类风湿关节炎(RA)患者肺功能的变化。方法将60例活动期RA患者分为肺功能降低组和肺功能正常组,观察2组临床症状和体征、实验室指标、健康指数(HAQ)积分、疾病活动度评分(DAS-28)及调节T细胞(Treg)的变化;采用肺功能仪检测活动期RA患者肺功能。结果 60例活动期RA患者中,肺功能降低42例(70%),肺功能正常者18例(30%)。与肺功能正常组比较,肺功能降低组血红蛋白明显降低(P0.05),其小气道阻塞差异率为60%以上,通气功能差异率为20%～30%;关节肿胀积分、15m步行时间、双手握力、倦怠乏力及X线分期显著升高(P0.05或P0.01)。Spearman相关分析得知,活动期RA患者肺功能参数与关节疼痛得分、关节压痛得分、双手握力、白细胞、红细胞、CD4+Treg、CD25+Treg、CD4+CD25+Treg、CD4+CD25+CD127-Treg均呈正相关(P0.05或P0.01);与关节肿胀得分、晨僵时间、15m步行时间、食少腹胀、症状总积分、IgM、IgA、补体C3、类风湿因子、X线分期均呈负相关(P0.05或P0.01)。结论活动期RA患者在发病过程中有一定程度的肺功能改变,肺功能变化以小气道阻塞、通气功能减退为主,并且与临床症状、体征及实验室指标呈高度相关性,所以定期动态观察RA患者的肺功能变化,对早期肺功能损害的预防、诊断和治疗有重要意义。

Study of the Correlation between Patients with Active Rheumatoid Arthritis and Pulmonary Function

Objective To study the changes of pulmonary function in patients with active rheumatoid arthritis （RA）. Methods Sixty patients with active RA were divided into tow lung function group and normal lung function group by detecting their pulmonary function. The clinical symptoms and signs, laboratory indicators, health index （HAQ） score, disease activity score （DAS-28） and regulate T-cells （Treg） were observed. Results In 60 patients with active RA, 42 cases （70%） were lower lung function and 18 cases （30%） were normal lung function. Compared with normal lung function group, Hb of low lung function group significantly lowered （P〈0.05）. Their differences in small airway obstruction rate was 60%, and in ventilation rate was 20%-30%. Joint swelling score, 15 m walking time, double-handgrip strength, fatigue weakness, X-ray phases were significantly higher （P〈0.05 or P〈0.01）. Spearman correlation analysis showed that there was a positive correlation between lung function parameters and joint pain score, joint tenderness score, double-handgrip strength, leukocytes, red blood cells, CD4＋ Treg, CD25＋ Treg, CD4＋ CD25＋ Treg, CD4＋ CD25＋ CD127- Treg （P〈0.05 or P〈0.01）, and a negative correlation between lung function parameters and joint swelling score, time of morning stiffness, 15 m walking time, eat less and abdominal distention, symptoms total score, IgM, IgA, Ca, RF, X-ray phases （P〈0.05 or P〈0.01）. Conclusion RA patients in active phase has a certain degree changes of lung function in small airway obstruction, ventilation dysfunction mainly, and highly correlated with clinical symptoms and signs, laboratory indicators. Periodic dynamic observation of changes in pulmonary function of RA patients has great significance for prevention, diagnosis and treatment of early lung function damage.