类风湿关节炎与原发性干燥综合征重叠患者继发间质性肺疾病的临床特点分析

目的 探讨类风湿关节炎（RA）与原发性干燥综合征（pSS）重叠患者继发间质性肺疾病（ILD）的临床特点、影像评分及预后的影响。方法 回顾性收集 43 例 RA 和 pSS 重叠（RA-pSS）患者的临床资料及肺高分辨率 CT（HRCT）资料，其中RA-pSS继发ILD组15例，RA-pSS未继发ILD组28例。2组患者年龄、性别、病程比较差异无统计学意义。观察RA-pSS患者的临床资料、肺功能、影像学改变，并对肺HRCT进行评分，分析RA-pSS继发ILD的临床、影像学特点及预后。结果 与RA-pSS未继发ILD组相比，RA-pSS继发ILD患者的C反应蛋白水平明显升高（P＜0.05）；RA-pSS 继发 ILD 组肺 HRCT 最常见的表现是小叶间隔增厚，最常见的 ILD 类型为非特异性间质性肺炎（NSIP）；与非普通型间质性肺炎（非-UIP）组相比，UIP组临床-影像-生理评分（CRP score）明显升高（P＜0.05）；与RA-pSS未继发ILD组相比，RA-pSS继发ILD组的生存率明显降低（P＜0.01）。结论 RA-pSS继发ILD患者炎性指标C反应蛋白水平更高，影像学表现复杂，预后差，应该得到临床的重视。

Clinical characteristics of secondary interstitial pulmonary disease in patients with rheumatoid arthritis and primary Sjogren's syndrome

Objective To investigate the clinical features, imaging scores, and prognosis of secondary interstitial lungdisease (ILD) in patients with overlapping rheumatoid arthritis and Sjögren’s syndrome (RA-pSS). Methods Clinical data and high-resolution lung CT (HRCT) data of 43 cases of RA-pSS patients were retrospectively collected including 15 cases of RA-pSS associated ILD and 28 cases of RA-pSS with non-ILD. There were no significant differences in age, gender and course of disease between the two groups. The clinical data, lung function, imaging changes in patients with RA-pSS, and score of the lung HRCT were observed, imaging characteristics and prognosis of RA-pSS associated ILD were analyzed. Results Compared with RA-pSS without secondary ILD group, patients with RA-pSS secondary to ILD showed significantly higher levels of C reactive protein (CRP, P＜0.05). RA-pSS secondary to ILD group showed the most common manifestation of interlobular septal thickening in high-resolution CT (HRCT). The most common type of ILD was nonspecific interstitial pneumonia (NSIP) in the RA-pSS secondary ILD group. Compared with the non-UIP group, the clinicalradiology-physiology score (CRP score) was significantly higher in the UIP group (P＜0.05). Compared with the RA-pSSwithout the secondary ILD group, the survival rate was significantly lower in the RA-pSS secondary ILD group (P＜0.01).Conclusion Patients with RA-pSS associated ILD have higher CRP for their inflammatory markers, complicated imaging characteristic and poor prognosis, and should receive clinical attention.