类风湿关节炎相关性间质性肺疾病的临床研究

Clinical study of rheumatoid arthritis-associated interstitial lung disease

目的探讨类风湿关节炎相关性间质性肺疾病（rheumatoid arthritis-associated interstitial lungdisease，RA—ILD）的临床特点和相关因素。方法回顾性分析我院2009年住院的135例RA病例。以患者首次出现RA症状为研究起点，以肺高分辨率CT检查发现ILD为研究终点。研究因素包括：性别、年龄、病程、临床表现（包括关节炎、类风湿结节、发热、口干及眼干、雷诺现象、皮疹等）、生化指标、免疫指标、治疗措施等40个变量。经后退法建立Logestic回归分析模型，计算OR值及95％CI。结果①135例RA患者中48例发生ILD，占35．6％。其中40例（83．3％）诊断RA平均（85±75）个月后确诊合并ILD；其中29例（60．4％）在检出ILD时无呼吸系统症状。②单因素分析显示RA-ILD组年龄、病程、咳嗽、呼吸困难、Velcro音、类风湿网子（rheumatoid factor，RF）、C3、γ-球蛋白高于RA无ILD组（P〈0．05或P〈O．01）。③经后退法建立Logestic回归分析模型，多因素分析显示咳嗽（OR=4．387，95％CI：1．143～16．831，P〈0．05）、Velero音（OR=6．727，95％CI：2．220～20．378，P〈0．01）、RF（OR=3．522，95％CI：1．304～9．512，P〈0．05）是RA—ILD的危险因素。④多因素分析发现的3个危险因素中，RF预测RA—ILD的敏感性最高（79．2％），咳嗽的阳性预测值最高（73．3％）。结论大多数患者RA的诊断先于ILD。部分RA患者的肺间质病变为亚临床型。咳嗽、Velcro音及RF阳性是RA患者发生肺间质病变的相关因素，当患者出现以上症状、体征或实验室检查异常时应该高度警惕发生肺间质病变可能，及时完善相关检查，给予合理治疗，改善预后。

Objective To analyse the clinical feature and risk factors of rheumatoid arthritis associated interstitial lung disease （RA -ILD）. Methods The data of 135 patients with rheumatoid arthritis （RA） hospitalized in the hospital in 2009 were retrospectively analyzed. The study factors included gender, age, disease duration, clinical manifestations （including arthritis, rheumatoid nodules, fever, dry mouth and dry eyes, Raynaud＇s phenomenon, skin rash）, biochemical and immunological indexes, and treatment measures. The date were analyzed with Logistic regression analysis. Results In 135 RA patients, 48 cases （35.6%） had interstitial lung disease （ILD）, in which 40 cases （83.3%） were diagnosed combined ILD （85±75） months after the diagnosis of RA,and 29 cases （60.4%） had no respiratory symptoms in the detection of lED. Univariate analysis showed that age, duration, incidence of cough, dyspnea and Velcro tone, positive rate of rheumatoid factor （RF）, C3 and 7-globulin in RA ILD group were higher than those in RA without ILD group （ P d0.05 or P 〈0.01）. Multivariate analysis showed that cough （OR =4.387,95% CI ： 1.143 16. 831, P %0.05）, Velcro tone （OR = 6. 727, 95% CI ：2.220-20.378, P〈0. 01） ,and RF （OR =3. 522,95% CI ：1.304 9.512, P 〈0.05） were risk factors of RA-ILD. Multivariate analysis identified that the sensitivity of RF was highest （79.2%）, and the positive predictive value of cough was highest （73.3%） in three risk factors. Conclusions RA is diagnosed before ILD in most of patients. The interstitial pulmonary damages of some RA patients are subclinical. Cough, Velcro tone and RF are interrelated factors of interstitial pulmonary damages in RA patients. When patients have these symptoms, signs or abnormal laboratory examination, interstitial lung disease should be highly alerted, the relevant checks should he consummated in time, and rational treatment should be carried out to improve prognosis.