类风湿关节炎相关间质性肺疾病的临床研究

Clinical investigation of rheumatoid arthritis-associated interstitial lung disease

目的研究类风湿关节炎相关间质性肺疾病(RA-ILD)的临床特点。方法选取136例行胸部CT扫描的类风湿关节炎(RA)患者,回顾性分析其临床及辅助检查资料。结果①符合RA-ILD的患者60例(44.1%);RA-ILD组年龄平均为(63.17±10.20)岁,RA病程>20年、有吸烟史、药物过敏史的患者构成比[(11/18.3%),(14/23.3%),(11/18.3%)]均高于单纯RA组[(58.25±10.22)岁和(5/6.6%),(7/9.2%),(2/2.6%)](P<0.05)。受累和畸形关节数[(12.22±3.44),(2.77±2.40)个]显著多于单纯RA组[(10.04±3.1),(1.09±1.81)个](P<0.01),双手腕关节X线平片分期[(2.87±0.78)期]和血清抗环瓜氨酸肽(CCP)抗体水平[(503.75±341.93)RU/ml]均高于单纯RA组[(2.53±0.65),(373.74±405.02)RU/ml](P<0.05);两组性别比、RA病情活动性及类风湿因子(RF)水平无明显差异。②RA-ILD患者主要表现为咳嗽(34/56.7%)和进行性胸闷(25/41.7%),其中20例(33.3%)无呼吸系统表现。③网格状影(35/60,58.3%)是RA-ILD最常见的胸部CT表现,其次为磨玻璃影(27/60,45.0%)、纤维索条影(24/60,40.0%);胸部X线平片诊断RA-ILD的误诊率和漏诊率分别为24.7%(18/73)和21.8%(12/55)。结论①RA常累及肺引起ILD;RA发生ILD与年龄、RA病程>20年、吸烟史、药物过敏史、RA病情严重度及抗CCP抗体有关;②无呼吸系统表现的RA-ILD患者比例较高,网格状影、磨玻璃影和纤维索条影是常见的胸部CT表现。

Objective To investigate the clinical characteristics of rheumatoid arthritis-associated interstitial lung disease （RA-ILD）. Methods 136 rheumatoid arthritis （RA） patients who completed chest CT scans were analyzed retrospectively. The clinical data and auxiliary examinations were observed. Results ①RA-ILD was diagnosed in 60 patients （44.1%）; the age （63.17±10.20） and the proportions of patients with RA disease duration20 years, smoking history, drug allergy history in RA-ILD group ／[（11/18.3%）, （14/23.3%）, （11/18.3%）／] were all higher than RA group ／[（58.25±10.22） and （5/6.6%）, （7/9.2%）, （2/2.6%）／]（P0.05）, the counts of involved and deformans joints ／[（12.22±3.44） and （2.77±2.40）／] were all significantly more than RA group ／[（10.04±3.1） and （1.09±1.81）／]（P0.01）, the stage of hands and wrists X-ray （2.87±0.78） accompanied with the levels of anti-cyclic citrullinated peptide （CCP） antibody ／[（503.75±341.93） RU/ml／] were all higher than RA group ／[（2.53±0.65）, 373.74±405.02） RU/ml／] （P0.05）. While sex proportion, RA disease’s activity and RF had no statistical differences between two groups; ②RA-ILD patients mainly complained of cough （34/56.7%） and progressive chest distress （25/41.7%）; 20 cases （33.3%） had no respiratory system’s manifestations; ③Reticulation （35/60, 58.3%） was the most frequent appearance in RA-ILD patients’ chest CT scans, ground-glass opacity （27/60, 45.0%） and fiber cord shadow （24/60, 40.0%） were followed. The rates of misdiagnosis and missed diagnosis using chest X-ray to diagnose RA-ILD were 24.7% （18/73） and 21.8% （12/55） respectively. Conclusions ①ILD is common in RA patients. The incidence of RA-ILD is related to the age, RA disease duration20 years, smoking history, drug allergy history, severity of RA and anti-CCP antibodies; ②The proportion of asymptomatic RA-ILD patients is high. Reticulation, ground-glass opacity and fiber cord shadow are mainly chest CT scan’s appearances.