系统性红斑狼疮患者525例肺部病变的调查

Prevalence survey on lung diseases of 525 patients with systemic lupus erythematosus

目的了解当前诊治条件下系统性红斑狼疮(SLE)患者的肺部病变表现和发生率。方法对525例1999-2003年来我院初诊的非感染性SLE病例进行胸部平片、高分辨率计算机断层摄影术(HRCT)、多普勒心脏彩超检查,分析临床和影像学表现。结果SLE肺部病变按发生率依次有胸膜炎/胸腔积液、间质性肺炎、肺动脉高压、小气道病变、急性狼疮肺炎、肺泡出血、肺挛缩综合征、肺栓塞等,总体发生率36.6%。男性胸膜炎累及率高于女性(37.5%vs24%,P<0.05)。大部分间质性肺炎的临床症状可不明显,发病时系统性红斑狼疮活动指数(SLEDAI)积分(7±4)分,与非间质性肺炎组差异无显著性。44%的病灶呈非对称性分布。早期渗出型病变全肺都可累及,晚期纤维化型病变以下肺和外周分布多见,36.8%纤维化型同时有渗出性病灶。经多普勒心脏彩超检查肺动脉高压发生率4.8%。结论肺是SLE常见的受累器官,总体发生率很高,表现多样,易与其他疾病混淆,值得引起重视和深入研究。

Objective To investigate the manifestations and prevalence of pulmonary involvement in patients with systemic lupus erythematosus(SLE)in condition of current diagnosis and treatment.Methods Five hundred and twenty five non-infected SLE patients who came to our hospital for the first time during1999-2003were subjected to examinations with chest radiograph,HRCT,Doppler echocardiography.Their clinical and radiological manifestations were analyzed.Results Ranking according to the prevalence,lung diseases of SLE including pleurisy/pleural effusions,interstitial pneumonia,pulmonary hypertension,small air way disease,acute lupus pneumonitis,pulmonary hemorrhage,shrinking lung syndrome,pulmonary embolism.The total prevalence of lung diseases in our patient cohort was up to36.6%.Pleuritis occured more commonly in men than in women(37.5%vs24.0%,P<0.05).The clinical manifestations of interstitial pneumonia might not be obvious and the SLEDAI scores were similar to those without interstitial pneumonia(7±4).Foty-four percent lesions were unsymmetrical.Exudation lesions found usually in earlier period could involve all parts of the lung while fibrotic lesions seen in later period mostly involved the lower and subpleural parts of the lung.Thirty-six poiot eight percent fibrotic lesions were accompanied by exudation.The prevalence of pulmonary hy-pertension detected with Doppler echocardiograph was4.6%.Conclusion Lung is involved in more than one-third SLE patients and its total prevalence is high.Pulmonary manifestations in SLE have variable clinical and radiogrphic manifestations which are likely to be confused with other lung diseases and deserve further study.