老年类风湿关节炎合并间质性肺疾病临床分析

The clinical analysis on rheumatoid arthritis-associated interstitial lung disease in the elderly patients

目的探讨老年类风湿关节炎(RA)合并间质性肺疾病(ILD)的发生率、临床特点、影像改变及肺功能的特点。方法回顾性分析520例RA患者中44例合并ILD患者(RA-ILD)的临床特点、影像学改变、肺功能情况。将RA-ILD患者按年龄分为老年组(A组,年龄≥60岁)和非老年组(B组,年龄<60岁),对上述两组患者临床资料进行对比分析。结果 (1)520例RA患者中老年RA合并ILD占老年RA患者的22.33%,非老年RA患者合并RA-ILD占非老年RA患者的5.33%,两组间比较差异有统计学意义(P<0.01)。男性RA-ILD占男性RA患者6.59%;女性RA-ILD占女性RA患者8.86%;RA-ILD发生率男女间比较,差异无统计学意义(P>0.05);(2)两组间发热、咳嗽、呼吸困难、吸烟、感染差异无统计学意义(P>0.05);老年组湿啰音发现率较非老年组高(P<0.05);(3)肺部HRCT提示磨玻璃影、网织影、蜂窝影表现,两组间比较差异无统计学意义(P>0.05);(4)肺功能两组比较:第1秒用力呼气容量(FEV1)、用力肺活量(FVC)、用力呼气流量平均值(FEF25%～75%)、用力呼出75%肺活量的呼气流量(FEF75%)老年组较非老年组下降显著(P<0.05);呼出全部气体所需时间(FET100%)老年组较非老年组高(P<0.05),提示限制性通气功能障碍及小气道改变显著。弥散量(DLCO)、弥散量/血管床面积(DLCO/VA)两组间差异无统计学意义(P>0.05)。结论老年RA比非老年RA更易合并ILD。老年RA患者查体发现湿啰音时应警惕是否合并ILD,临床医师对于老年RA患者应更重视早期行肺HRCT及肺功能检查。老年RA-ILD患者小气道改变及限制性通气功能障碍较非老年RA-ILD更易发生,提示应早期改善老年RA-ILD肺功能。

Objective To analyze the incidence, clinical characteristics, image features and pulmonary function tests of rheumatoid arthritis-interstitial lung disease （RA-ILD） in the elderly patients. Methods The clinical characteristics, image features and pulmonary function tests of 44 patients with RA-ILD among 520 patients with RA were retrospectively analyzed. The RA-ILD patients were divided into 2 groups by age： elderly group （group A, age ≥60 years old） and non-elderly group （group B, age 〈60 years old）. The clinical data between the 2 groups were compared and analyzed. Results （1） Among the 520 patients with RA, the ratio of elderly patients with RA-ILD was 22.33% in the elderly patients with RA, and the ratio of non-elder patients with RA-ILD was 5.33% in the non-elder patients with RA. There were significant differences between the 2 groups （P〈0.01）. In the male patients, the ratio of patients with RA-ILD was 6.59% in the patients with RA, which was 8.86% in the female patients. There were no significant differences between the male and female patients （P〉0.05）; （2） The differences in the clinical manifestations of fever, cough, dyspnea, smoking and infection between the 2 groups were not statistically significant （P〉0.05）. The moist crackles were more frequently found in group A than in group B （P〈0.05）; （3） According to the high-resolution computed tomography （HRCT） of the lung, there were no significant differences in the ground glass shadow, grid shadow and cellular shadow image performance between group A and group B （P〉0.05）; （4） The pulmonary function tests were obviously lower in group A than that in group B （P〈0.05）, including forced expiratory volume in the first second （FEV1）, forced vital capacity （FVC）, forced expiratory flow from 25% to 75% of FVC （FEF25%-75%） and forced expired flow at 75% of FVC （FEF75%）. And the forced expiratory time to reach 100% of VC （FET100%） was shorter in group B than that in group A （P〈0.05）. The restrictive ventilation function abnormality and small airway dysfunction were significantly changed. The diffusing capacity and diffusing capacity/vascular bed area between the 2 groups were not significantly different （P〉0.05）. Conclusions The incidence of RA-ILD in the elderly patients with RA is higher than that in the non-elderly patients with RA. More attention should be paid to the elderly RA patients with moist crackles in case of RA-ILD. The HRCT of the lung and pulmonary function tests should be carried out in the elderly patients with RA in the early stage by clinicians. The small airway dysfunction and restrictive ventilation function abnormality occur more frequently in the elderly patients with RA-ILD than in the non-elderly patients with RA-ILD. The pulmonary function of the elderly patients with RA-ILD should be improved as early as possible.