80例血管炎合并间质性肺疾病的临床特征及预后分析

Clinical characteristics and prognosis analysis of 80 cases of vasculitis complicated with interstitial lung disease

目的比较ANCA相关性血管炎(AAV)继发间质性肺病(ILD)与其他类型ILD患者的临床特征,以探讨其病理生理学差异、临床诊断意义及预后。方法回顾性分析2009年1月至2023年1月新疆维吾尔自治区中医医院80例AAV-ILD患者与80例非AAV-ILD患者,对比两组临床表现、实验室检测、影像学特征、肺功能及Warrick评分,并对AAV-ILD组按存活状态进行亚组分析。结果(1)AAV-ILD组在肺心病、2型糖尿病、高血压合并症及发病年龄、就诊年龄、发热、Velcro啰音、WBC、N、CRP、ESR、PCT、IL-6、BUN、DD、尿潜血发生率均高于非AAV-ILD组,而RBC、HGB低于非AAV-ILD组,差异具有统计学意义;(2)高水平IL-6、罹患冠心病是AAV-ILD患者死亡的独立危险因素,Warrick评分与DLCOc%呈负相关,与FEV1/FVC呈正相关。结论AAV-ILD患者呈特定临床表型,高水平的IL-6与冠心病存在是预后不良的重要指标,提示个体化治疗及预后评估的新方向。

Objective To compare the clinical characteristics of patients with anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV)complicated with interstitial lung disease(ILD)and other types of ILD in order to explore the pathophysiological differences,clinical diagnostic significance,and prognosis.Methods A retrospective analysis was conducted on 80 AAV-ILD patients and 80 non-AAV-ILD patients in the hospital of Traditional Chinese Medicine of Xinjiang Uygur Autonomous Region from January 2009 to January 2023.The clinical manifestations,laboratory tests,imaging features,pulmonary function,and Warrick score between the two groups were compared,and a subgroup analysis of the AAV-ILD group was performed according to survival status in the AAV-ILD group.Results①The AAV-ILD group had a higher incidence of cardiomegaly,type 2 diabetes,hypertension,as well as higher age of onset,age of treatment,fever,Velcro rales,WBC,N,CRP,ESR,PCT,IL-6,BUN,DD,and hematuria occurrence rate compared to the non-AAV-ILD group,while RBC and HGB were lower than those in non-AAV-ILD group,with statistically significant differences.②High levels of IL-6 and comorbid coronary heart disease were independent risk factors for mortality in AAV-ILD patients,and the Warrick score was negatively correlated with DLCOc%and positively correlated with FEV1/FVC.Conclusion AAVILD patients exhibit specific clinical phenotypes.High levels of IL-6 and the presence of coronary heart disease are important indicators of poor prognosis,suggesting a new direction for individualized treatment and prognosis assessment.