类风湿性关节炎患者间质性肺疾病的临床概况

目的了解类风湿性关节炎肺间质病变的发生情况、特征及相关因素分析，以便早期发现类风湿性关节炎的肺部病变。方法类风湿性关节炎患者45例，免疫比浊法检测类风湿因子、C反应蛋白、免疫球蛋白及补体；间接免疫荧光法和免疫印迹法检测抗核抗体及亚类。血气分析测定氧分压、动脉血二氧化碳分压和肺泡-动脉血氧分压差。肺功能仪测定潮气容积、最大肺活量、用力肺活量、第1秒用力呼气容积、最大呼气中段流量、最大通气量和一氧化碳弥散功能。放射学检查包括胸部正侧位X线片、双手像和肺高分辨率CT扫描。结果45例类风湿关节患者中，14例存在肺间质病变，其中10例有呼吸道症状。肺功能检测异常主要为弥散功能降低和限制性通气障碍。8例胸部X线片存在异常，14例高分辨率CT发现异常。肺高分辨率CT在发现类风湿性关节炎肺间质病变病变时优于普通胸部X线片。结论类风湿性关节炎肺间质病变的发生与疾病活动性和严重性相关，肺弥散功能、高分辨率CT在早期发现病变时有诊断意义。

Interstitial lung disease in patients with rheumatoid arthritis

Objective To investigate the prevalence and clinical manifestation of rheumatoid arthritis-inter-stitial lung disease(RA-ILD). Methods Forty-five inpatients with rheumatoid arthritis(RA) were enrolled. Serum rheumatoid factor (RF), C reactive protein (CRP), immunoglobulin (IgG, IgA, IgM), and compliment (C3, C4) were measured by immunoncphelometry. Antinuclear antibodies (ANAs) and anti-extractable nuclear antigen(anti-ENA) antibodies were measured by indirect immunofluorescence technique and Western blot. Arterial gas analysis included PaO2, PaCO2, and PA-zO2. The following pulmonary function tests were performed: tidal volume(VT), maximal vital-capacity (Vcmax), forced vital capacity (FVC), one second forced expiratory volume (FEV1), FEV1/FVC, maximal mid-expiratory flow(MMFF), maximal voluntary ventilation(MVV) and diffusing capacity CO (DLCO). Radiology examinations included chest X radiographs, hand radiographs and chest HRCT. Results abnormal findings included interlobular septal thickening, bronchovascular bundles thickening, sub pleura] lines, re-ticular appearances, ground glass capacity and honeycomb changes. HRCT was more sensitive than chest radio-graphy. Conclusions The incidence of RA-ILD is associated with the activity and severity of RA. DLCO and HRCT are important for early detection of disease.