类风湿关节炎患者肺间质病变的临床特点及血清细胞因子的变化

目的 探讨类风湿关节炎(RA)肺间质病变(RA-ILD)的临床特点和血清转化生长因子(TGF)-β1、肿瘤坏死因子(TNF)-α、胰岛素样生长因子(IGF)-1和血小板源性生长因子(PDGF)-AB的变化规律.方法 随机观察比较30例RA-ILD病人和35例RA病人,主要观察指标有性别、年龄、病程、收缩压、舒张压、呼吸次数、休息痛,病人评价和医生评价,晨僵时间、握力、压痛关节数、压痛关节指数、肿胀关节数、肿胀关节指数,关节功能评价,手X线分期,日常生活能力(HAQ)、肺部高分辨CT(HRCT)、肺功能、动脉血气分析等指标.对所有病人测定了细胞因子TGF-β1、TNF-α、IGF-1和PDGF-AB浓度.结果 与RA病人相比,RA-ILD组病人年龄偏大、病程较长,休息痛、病人评价和医生评价较重,晨僵时间长,握力小,压痛关节数和压痛关节指数、肿胀关节数和肿胀关节指数均较高,关节功能评价和手X线分期较严重,日常生活能力较差(P＜0.05,P＜0.01).RA-ILD组病人红细胞沉降率较快,血清C反应蛋白较高、类风湿因子滴度高、球蛋白含量高,肺动脉压测定值高等(P＜0.01).RA-ILD病人主要呼吸系统表现有咳嗽、咳痰、胸闷、气短、胸痛、呼吸音改变、Velcro 罗音、活动后呼吸困难等.RA-ILD和RA病人在Vc、FVC、MMF和DLCO指标差异有统计学意义(P＜0.01).RA-ILD病人主要表现为弥散功能下降(83%)、限制性通气障碍(63%),阻塞性通气障碍(26%)、小气道功能受损(42%),混合性肺功能障碍(16%).与正常对照组相比,RA-ILD病人血清TGF-131、TNF-α、IGF-1、PDGF-AB水平明显增高(P＜0.01),RA病人上述细胞因子也明显升高(P＜0.01).与RA病人相比,RA-ILD病人血清TGF-β1、TNF-α、IGF-1、PDGF-AB明显增高(P＜0.01).结论 RA-ILD病人多项临床活动指标较RA病人严重,肺部HRCT有明显的影像学改变,肺功能下降,动脉血气分析可有低氧血症,血清细胞因子TGF-131、TNF-α、IGF-1、PDGF-AB明显增高.

Clinical observation of rheumatoid arthritis associated interstitial lung disease patients and changes of serum cytokines thereof

Objective To observe the clinical feature of rheumatoid arthritis associated interstitial lung disease(RA.ILD)patients and changes of serum cytokines tumor growth factor(TGF)-β1,tumor necrosis factor(TNF)-α,insulin-like growth factor(IGF)-1,and platelet derived growth factor(PDGF)-AB.Methods The clinical manifestations,lung high resolution CT(HRCT),lung functions,blood gasand other relative laboratory findings of 30 RA-ILD patients and 35 RA patients were observed.ELASA Was used to detect the levels of TGF-β1,TNF-α,IGF-l,and PDGF-AB.Thirty healthy volunteers were observed too as controls.Results The clinical manifestations of RA-ILD patients were more serious than those of the RA patients.The ESR Was faster,the serum C-reactive protein,rheumatoid factor(RF),and globulin levels hisher,and pulmonary arterial pressure higher too in the RA-ILD patients than in the RA patients(all P＜0.01).The main respiratory manifestations of the RA-ILD patients were cough,expectoration,chest distress,short breath,chest pain,change of breath sounds,Velcro rales,and dyspnea.The main lung HRCT findings included thickening of interlobular septum and bronchial wall,pachynsis pleurae,mosaic sign,bronchieetasis,emphysema,patching shadow,honeycombing,fibrous seal,etc.Pulmonary funetion test showed that the levels of vital capacity.forced vital capacity,maximam mid-expiratory flow.and diffusing capacity of the lung for carbon monoxide of the RA-ILD patients were all significantly lower than those of the RA patients(all P＜0.01).Arterial gas test showed that the PO,of the RA-ILD patients Was significantly lower than that of the RA patients(P＜0.01).The TGF-β1;TNF-α,IGF-1,and PDGF-AB of both the RA-ILD and RA patients were all significantly higher than those of the healthy volunteers(all P＜0.01).and the levels of these cytokines of the RA-ILD patients were all higher than those of the RA patients(all P＜0.01).Conclusion The symptoms and signs of the RA-ILD patients are more serious,the lung HRCT changes more obvious,lung function decreases,and the levels of TGF-β1,TNF-α.IGF-1.and PDGF-AB increase.