类风湿关节炎合并间质性肺炎的临床病例分析

目的 分析RA患者合并IP的临床特征及治疗预后,为此类患者的治疗提供临床依据.方法 收集196例RA患者,其中20例合并IP,纳入IP组,余下176例RA患者纳入单纯RA组.同时根据患者是否存活将IP组分为死亡IP组3例和存活IP组17例.比较IP组与单纯RA组、死亡IP组与存活IP组的临床资料及疗效.结果 IP组有雷...     

肺康复训练对类风湿关节炎合并肺间质病变患者肺功能的影响

目的 探讨肺康复训练对类风湿关节炎（RA）合并肺间质病变（ILD）患者肺功能的影响.方法 将RA-ILD患者33例,其中男4例,女29例,随机分为两组：肺康复训练组16例（A组）、常规治疗组17例（B组）,对两组患者进行前瞻性研究;两组均用常规的慢作用药物治疗RA,A组又在B组治疗基础上给予肺康复训练.分别在治疗前、治疗2、4个月后对患者肺功能进行测定,并对疼痛和生活能力进行评价.结果 两组患者治疗前,其肺功能各项指标[包括肺活量（VC）、用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、最大通气量（MVV）]组间差异均无统计学意义（P＞0.05）;分别经2、4个月治疗后,结果发现肺康复训练组（A组）肺功能指标均较治疗前及对照组（B组）明显提高（P＜0.05）,且随锻炼时间延长、强度增加改善尤为显著,与对照组同时间段比较,组间差异均具有统计学意义（P＜0.01）;对照组治疗前、治疗后2、4个月上述指标好转,但差异均无统计学意义（P＞0.05）.在疼痛和生活能力评分两方面也有一定程度的改善,但治疗前后比较差异无统计学意义.结论 RA-ILD患者恢复期给予渐进式肺康复训练,可进一步改善RA-ILD患者心肺功能,增强患者的体能,还能显著改善患者日常生活活动能力,促其早日回归家庭及社会.因此,在RA治疗的基础上加呼吸功能训练是RA-ILD恢复期患者既经济又理想的治疗手段,肺功能检查是疗效动态评价的主要指标之一.     

类风湿关节炎患者肺功能的变化及新风胶囊对其的影响

目的观察类风湿关节炎(Rheumatoid arthritis,RA)患者肺功能的变化及中药新风胶囊对其的影响。方法检测80例类风湿关节炎患者和14名健康对照者的肺功能,并将其中40例RA患者按随机数字表分为新风胶囊实验组和正清风痛宁对照组,观察RA患者肺功能及两组治疗前后肺功能的变化。结果类风湿关节炎患者IC、MVV、FVC、FEV1、FEF25、FEF50、FEF75和PEF均明显低于健康对照组(P<0.05或P<0.01)。治疗后,实验组IC、MVV、FEF25、FEF50、PEF均明显升高(P<0.05或P<0.01),对照组MVV、FVC明显升高(P<0.05或P<0.01)。实验组治疗后FEF25、FEF50、FEF75、PEF的均值均显著高于对照组(P<0.05或P<0.01)。结论RA患者的肺功能多个参数显著降低,以通气功能障碍为主,并伴小气道阻塞和肺容积减少。中药新风胶囊通过调节免疫,降低炎症活动性指标改善RA患者肺功能。     

类风湿关节炎对患者心理因素的影响

类风湿关节炎（RA）是一个累及周围关节为主的多系统性炎症性的自身免疫疾病，常持续和反复发作。目前尚缺乏根治及预防本病的有效措施。对RA患者来说，长期遭受疾病所致的疼痛、致残、丧失劳动能力、治疗不适和心理压力等是最大危害。本文就影响RA患者心理状态的因素作一综述。     

血流限制训练对类风湿关节炎患者下肢关节功能恢复的影响

目的:观察血流限制训练(BFRT)对类风湿关节炎(RA)患者下肢关节功能恢复的影响。方法:采用随机数字表法将60例RA患者分为观察组及对照组,每组30例。2组患者均给予常规药物治疗(慢作用抗风湿药物+小剂量糖皮质激素)及基础运动训练(包括关节训练和肌力训练),观察组患者在此基础上辅以BFRT训练,训练过程中保持腹股沟部...     

肺功能受损肺炎患儿呼吸功能训练的临床研究

[目的]探讨呼吸功能训练对肺功能受损肺炎患儿的康复效果。[方法]选取来我院儿科病房住院的中度肺功能受损肺炎患儿162例,随机分为实验组和对照组,实验组患儿采用常规治疗、护理+呼吸功能训练,对照组患儿采用常规治疗、护理,观察两组患儿的并发症发生情况、肺功能恢复情况和肺部疾病的复发情况。[结果]实验组在并发症发生率、2周时肺功能恢复情况和肺部疾病复发率方面与对照组比较,差异具有统计学意义(P<0.05)。[结论]呼吸功能训练能减少肺功能受损肺炎患儿的并发症,缩短其肺功能的康复时间,同时降低肺部疾病的复发率。     

吡非尼酮对老年类风湿关节炎合并间质性肺炎的疗效观察

目的 探讨吡非尼酮对老年类风湿关节炎合并间质性肺炎的疗效和安全性.方法 收集的RA合并IP患者42例.根据随机数字表法将患者分为观察组和对照组,每组各21例.对照组给予硫酸羟氯喹治疗.观察组在对照组基础上加用吡非尼酮治疗.对比两组的疾病活动程度及CRP、ESR、RF、晨僵时间及动脉血氧分压情况.结果 治疗后,观察组晨僵...     

呼吸功能训练对尘肺患者肺功能的影响

目的 探讨呼吸功能训练对尘肺患者肺功能的影响。 方法 选择2011年6月－2012年9月住院的100例尘肺患者,按随机数字表法分为试验组和对照组各50例,对照组给予常规治疗、护理和健康教育,试验组在对照组基础上,增加使用肺功能锻炼器进行呼吸训练。观察两组患者治疗前后的第1秒用力呼气量、肺活量、最大通气量、用力肺活量、自觉气短与气急分级以及日常生活能力分级的变化。 结果 试验组患者6个月后的肺功能指标、自觉气短与气急分级以及日常生活能力分级较治疗前均有改善,并明显优于对照组,两组比较差异有统计学意义（P＜0.05）。试验组患者的第1秒用力呼气量（2.75 ± 0.43）L、肺活量（3.29 ± 0.45）L,明显高于对照组,差异有统计学意义（P＜0.05）;试验组患者的自觉气短与气急分级（2.10 ± 0.67）级、日常生活能力分级（2.19 ± 0.66）级,与对照组相比,差异有统计学意义（P＜0.05）。 结论 使用肺功能锻炼器进行呼吸功能训练能够改善患者肺功能,改善呼吸困难程度,提高尘肺患者的生活质量。     

针灸对类风湿关节炎患者的相关指标

目的 探讨针灸治疗类风湿关节炎(RA)患者,对RA相关指标及炎性指标的影响.方法 选择2018年12月～2019年12月我院收治的RA患者78例,根据盲抽法将其分为观察组和对照组各39例.对照组给予常规西药治疗,观察组在对照组基础上给予针灸治疗.比较治疗后两组患者临床体征变化情况、RA相关指标及炎性指标水平.结果 治疗...     

类风湿关节炎合并间质性肺病的临床特点分析

目的探讨类风湿关节炎（RA）合并间质性肺病（ILD）的临床特点。方法回顾性分析2012年3月至2014年3月住院的201例RA患者的病例资料,按有无合并间质性肺病分为单纯RA组176例,RA-ILD组25例,分析比较ILD-RA的发生率、临床特征和相关危险因素。结果 RA-ILD发病率为12.44%;两组性别、发病年龄及吸烟史比较差异均有统计学意义（P〈0.05）,病程、关节肿胀数及关节压痛数比较差异无统计学意义（P〉0.05）。两组RF、CRP、抗CCP抗体及Ig G比较差异均有统计学意义（P〈0.05）,ESR、C3、C4、ANA及SSA（阳性/阴性）比较差异均无统计学意义（P〉0.05）。网格影为RA-ILD高分辨率CT（HRCT）最常见影像学表现。结论老年、男性、RF滴度高可能是RA-ILD发病的危险因素。HRCT对RA-ILD患者的早期诊断具有重要的价值。     

血清抗环瓜氨酸肽抗体与类风湿关节炎合并间质性肺疾病的相关性分析

目的探讨血清抗环瓜氨酸肽(CCP)抗体与类风湿关节炎(RA)合并间质性肺疾病(ILD)的相关性。方法选择RA患者共57例,其中RA-ILD患者22例(研究组),RA未合并ILD患者35例(对照组),检测RA患者抗CCP抗体、类风湿因子(RF)、C反应蛋白(CRP)、红细胞沉降率(ESR)、IgG、IgA、IgM水平,采用疾病活动评分(DAS28)评估疾病活动性,并进行统计分析。结果抗CCP抗体在高滴度水平即抗CCP抗体500 U/ml时,研究组的CCP抗体500 U/ml的人数比率著高于对照组。两组在各种滴度分组下的RF水平均无统计学差异。研究组RF滴度与抗CCP抗体水平无明显相关性(r=0.192,P=0.637),两组其余各项指标也无统计学差异。结论高滴度抗CCP抗体在评价RA-ILD方面有一定的参考价值,较RF好。对高滴度抗CCP抗体的RA患者应注意间质性肺疾病的发生。     

类风湿性关节炎与肺间质性病变

目的：探讨类风湿性关节炎（RA）患发生肺间质性病变（ILD）的相关性及其危险因素。方法：对30例类风湿性关节炎X线有间质性肺病变的患，和30例类风湿性关节炎无肺间质性病变的患进行回顾性分析。结果：类风湿性因子（RF）滴度超过1：60容易发生间质性肺病变（P＜0．05），肺间质病变严重程度与类风湿因子滴度呈正相关（P＜0．05），吸烟也加重肺间质性病变（P＜0．05），结论：类风湿性因子滴度越高，发生间质性肺病变的危险性越大，临床出现症状的时间越短，X线上表现亦越严重，病程，吸烟也是影响肺间质性病变的危险因素。     

Effect of continuous nursing combined with respiratory exercise nursing on pulmonary function of postoperative patients with lung cancer

BACKGROUND Lung cancer is a malignant tumor with high morbidity and mortality among cancers. Surgery is currently one of the primary methods of treating lung cancer. Although it can slow down the progression of the disease by removing the lesion, this invasive surgery inevitably damages the integrity of the patient’s chest. Moreover, the patient’s pulmonary function may have a low compensatory capacity after surgery, causing various respiratory diseases such as atelectasis, respiratory function ...     

Anti-cyclic citrullinated peptide antibodies in lung diseases associated with rheumatoid arthritis

Objective

Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific markers for rheumatoid arthritis (RA) and useful for predicting RA development and progression. However, it has not been fully determined whether anti-CCP antibodies are associated with pulmonary diseases in RA patients. In the present study, we aimed to elucidate the relationships between anti-CCP antibodies and pulmonary diseases, particularly interstitial lung disease (ILD) and bronchiolitis.

Design and methods

Using an enzyme-linked immunosorbent assay, the presence of serum anti-CCP antibodies was examined in 18 RA patients with ILD and bronchiolitis who were diagnosed based on pathologic findings. A further 36 RA subjects without any pulmonary diseases served as a reference population.

Results

No significant differences were found for the prevalences and levels of anti-CCP antibodies between patients with and without ILD and follicular bronchiolitis.

Conclusion

Detection of serum anti-CCP antibodies has no association with pulmonary diseases in RA patients.     

Shoulder function and active motion deficit in patients with rheumatoid arthritis

Purpose: To discover whether there are differences between patients with RA with and without active motion deficit in the shoulder (passive ROM greater than active ROM) concerning disease characteristics and shoulder function, and examine the role of active motion deficit in explaining limitations of shoulder function in daily life. Methods: This cross-sectional study included 123 patients with RA having shoulder pain. Disease activity and duration of shoulder pain and disease were registered, active and passive shoulder ROM, pain and muscle strength were measured. Shoulder function in daily life was assessed by Disability of the Arm, Shoulder and Hand (DASH). Results: Patients with active motion deficit (36%) had statistical significant worse scores on disease activity, shoulder pain, muscle strength, and DASH function than those without active motion deficit (p ≤ 0.05). No differences between the groups were found for duration of shoulder pain or disease (p > 0.05). Active motion deficit, passive ROM, muscle strength and pain explained 33.7% of the variation in the DASH function score. Conclusion: Active motion deficit in the shoulder seems frequent in patients with RA. Together with passive ROM, muscle strength and pain, active motion deficit explained about one-third of the limitations in shoulder function in daily life.

Implications for Rehabilitation

• Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints and periarticular tissue. Pain, muscle weakness, and joint destruction may result in reduced range of motion (ROM), which in turn may affect the performance of activities in daily life.

• Shoulder affection is frequent in patients with RA. About one-third of the patients in the present study had an active motion deficit in the shoulders.

• Patients with active motion deficit had more shoulder pain and more impaired shoulder function than those without deficit. Active motion deficit associated with limitations in shoulder function in daily life.

     

延续性功能锻炼指导对类风湿性关节炎患者生活质量的影响

目的探讨延续性功能锻炼指导对类风湿性关节炎患者生活质量的影响。 方法选取中国医科大学附属盛京医院第一风湿免疫内科2018年6月至12月收治的120例类风湿性关节炎患者为研究对象,采用随机抽签法将患者分为观察组和对照组,各60例。对照组患者出院时给予健康指导,嘱患者按时复诊,出院后进行电话随访1次。观察组在对照组的基础上出院后进行延续性功能锻炼指导。采用慢性病自我管理行为量表评价患者出院后自我管理情况,评价患者临床症状的控制情况,采用类风湿性关节炎患者生活质量量表评价患者出院后的生活质量。采用t检验比较组间上述相关评分的差异。 结果观察组出院后3个月,锻炼、认知性症状管理实践、与医师的沟通评分分别为（9.96±1.14）分、（8.97±1.34）分、（6.32±1.28）分,高于对照组的（8.93±1.18）分、（7.96±1.32）分、（5.44±1.51）分,差异均具有统计学意义（t=4.863、4.159、3.442,P<0.001、<0.001、=0.001）。观察组出院后3个月晨僵时间短于对照组［（1.05±0.47）h vs （1.34±0.56）h］,关节疼痛评分低于对照组［（1.34±0.75）分vs（2.48±0.89）分］,关节疼痛个数少于对照组［（3.74±1.31）个vs（5.28±1.61）个］,差异均具有统计学意义（t=3.073、7.587、5.677,P=0.002、<0.001、<0.001）。观察组干预后3个月在心理领域、生理领域、社会领域、健康自我认识及总的健康状况与生存质量方面评分分别为（3.72±1.15）分、（6.20±2.24）分、（5.43±1.37）分、（3.53±1.25）分、（5.72±2.26）分,均高于对照组的（1.59±0.57）分、（3.06±1.32）分、（3.21±1.08）分、（1.35±0.49）分、（2.14±1.15）分,差异均具有统计学意义（t=12.855、9.355、11.559、12.577、10.936,P均<0.001）。 结论延续性功能锻炼指导能够提高类风湿性关节炎患者对疾病的自我管理能力,有利于控制临床症状,改善患者的生活质量。     

Prognostic value of cardiovascular magnetic resonance derived right ventricular function in patients with interstitial lung disease

Background

Cardiovascular magnetic resonance (CMR) provides non-invasive and more accurate assessment of right ventricular (RV) function in comparison to echocardiography. Recent study demonstrated that assessment of RV function by echocardiography was an independent predictor for mortality in patients with interstitial lung disease (ILD). The purpose of this study was to determine the prognostic significance of CMR derived RV ejection fraction (RVEF) in ILD patients.

Methods

We enrolled 76 patients with ILD and 24 controls in the current study. By using 1.5 T CMR scanner equipped with 32 channel cardiac coils, we performed steady-state free precession cine CMR to assess the RVEF. RV systolic dysfunction (RVSD) was defined as RVEF ≤45.0% calculated by long axis slices. Pulmonary hypertension (PH) was defined as mean pulmonary artery pressure (mPAP) of more than 25 mmHg at rest in the setting of pulmonary capillary wedge pressure ≤15 mmHg.

Results

The median RVEF was 59.2% in controls (n = 24), 53.8% in ILD patients without PH (n = 42) and 43.1% in ILD patients with PH (n = 13) (p < 0.001 by one-way ANOVA). During a mean follow-up of 386 days, 18 patients with RVSD had 11 severe events (3 deaths, 3 right heart failure, 3 exacerbation of dyspnea requiring oxygen, 2 pneumonia requiring hospitalization). In contrast, only 2 exacerbation of dyspnea requiring oxygen were observed in 58 patients without RVSD. Multivariate Cox regression analysis showed that RVEF independently predicted future events, after adjusting for age, sex and RVFAC by echocardiography (hazard ratio: 0.889, 95% confidence interval: 0.809 – 0.976, p = 0.014).

Conclusions

The current study demonstrated that RVSD in ILD patients can be clearly detected by cine CMR. Importantly, low prevalence of PH (17%) indicated that population included many mild ILD patients. CMR derived RVEF might be useful for the risk stratification and clinical management of ILD patients.     

肺癌患者术前呼吸功能锻炼对肺功能的影响

目的 评估术前强化呼吸锻炼对改善肺功能的效果.方法 将80例拟开胸行肺癌根治术的患者随机分为观察组和对照组各40例.对观察组患者,术前2周进行强化呼吸锻炼,对照组接受常规围手术期护理.观察比较观察组锻炼前后肺功能的变化,并与对照组的术后并发症出现情况进行比较.结果 观察组患者锻炼后血氧分压(PaO_2)、血氧饱和度(SpO_2)、时间最大通气量(MVV)、肺总量(TCL)、时间肺活量(FEV)较锻炼前明显改善,术后并发症发生率较对照组明显降低.结论 强化呼吸锻炼对改善开胸根治术肺癌患者肺功能,提高对开胸手术的耐受力及有效减少术后并发症的发生率有着重要临床意义.     

RA患者免疫功能失衡与疾病活动情况的关系研究

目的探讨类风湿关节炎(RA)患者免疫功能失衡与患者疾病活动程度的关系。方法选取我院类风湿免疫科确诊的RA患者90例(RA组)、健康体检志愿者60例作为对照组;检测两组对象外周血中Th17细胞、调节性T细胞(Treg)、血清γ干扰素(IFN-γ)、白细胞介素-4(IL-4)、C反应蛋白(CRP)、血沉(ESR),并分析Th17细胞、Treg、IFN-γ、IL-4与患者关节疼痛数目、类风湿关节炎病情评价(DAS28评分)的相关性。结果 RA组患者的Th17细胞、血清IFN-γ均高于对照组(P<0.05),RA组患者的Treg细胞低于对照组(P<0.05);RA组患者的血清CRP、ESR水平均高于对照组(P<0.05);DAS28评分>5.1分RA患者的Th17细胞、血清IFN-γ均高于≤5.1分的患者(P<0.05),DAS28评分>5.1分RA患者的Treg细胞低于≤5.1分的患者(P<0.05);RA患者的Th17细胞、血清IFN-γ与DAS28评分、压痛关节数目呈显著正相关(P<0.05),RA患者的Treg细胞与DAS28评分、压痛关节数目呈显著负相关(P<0.05)。结论 RA患者T细胞及免疫学因子失衡可能与患者疾病活动程度、病情严重程度有关。