老年类风湿关节炎并肺间质病变26例临床分析

Clinical analysis of 26 cases of interstitial lung disease in old patients with rheumatoid arthritis

目的探讨老年类风湿关节炎(RA)并发间质性肺病的临床特点、实验室、肺功能、影像学检查,加深对RA肺间质病变的认识。方法回顾我院2003年1月至2008年4月期间26例RA并发间质性肺病患者的临床资料,包括类风湿因子(RF)滴度、血补体、免疫球蛋白及循环免疫复合物(C IC)含量、血气分析、肺部高分辨CT(HRCT)、肺功能检查等。结果本组患者中高滴度RF22例,血沉增高25例,C反应蛋白升高20例,免疫球蛋白IgG增高17例,IgM增高14例,循环免疫复合物增高15例,补体CH50降低19例、低氧血症16例,3例死亡,死亡原因为感染后诱发的I型呼吸衰竭。结论间质性肺病的发生与重症类风湿关节炎有关联,患者应尽早作肺部高分辨CT(HRCT)、肺功能检查,以早期诊断和治疗肺部病变,尤其是高滴度RF的RA患者。

Objective： To explore the clinical characteristics,pulmonary function,labratory examination and radiographic findings of interstitial lung disease in old patients with rheumatoid arthritis（RA）,and to deeply understand interstitial lung disease in rheumatoid arthritis.Methods： The clinical dates of 26 admitted interstital lung disease（ILD） in old RA patients from January 2000 to July 2008 were analyzed retrospectively including rheumatoid factor（RF）,blood complement,immunoglobulin and circulatory immunocomplex,blood-gas analysis,chest HRCT,pulmonary function tests.Results： Among the 26 RA patients with ILD,22 cases were with strongly positive RF,25 cases with elevated ESR,20 cases with elevated CRP,17 cases with elevated IgG,14 cases with elevated IgM,15 cases with elevated CIC,19 cases with decreased CH50,and 16 cases with hypoxemia,3 cases of death.The cause of the death was type I respiratory failure with pulmonary infections.Conclusion： ILD is related to the severity of rheumatoid arthritis,chest HRCT and pulmonary function test should be taken early in order to get early diagnosis and treatment,especially in those with strongly positive RF.