类风湿关节炎合并间质性肺病的临床特点

Clinical analysis of rheumatoid arthritis complicated with interstitial lung disease

目的分析类风湿关节炎(rheumatoid arthritis,RA)合并间质性肺病(interstitial lung disease,ILD)患者的临床特点。方法回顾性分析2009年6月至2011年6月住院的322例RA患者的临床症状、实验室和影像学检查及治疗转归。按有无间质性肺病分为RA无ILD组283例,RA-ILD组39例。对各组患者的临床资料进行系统分析。结果 322例RA患者合并ILD的患病率为12%,且多见于50岁以上患者(85%);RA-ILD组中男性患者的比例较RA无ILD组高,差异有统计学意义(P=0.002);RA-ILD组的发病年龄显著高于RA无ILD组,差异有统计学意义(P=0.000)。RA-ILD组RF滴度较RA无ILD组显著增高,差异有统计学意义(P=0.013),两组间病程、关节肿胀数、关节压痛数、血沉(ESR)、C反应蛋白(CRP)、抗环瓜氨酸肽(CCP)抗体、免疫球蛋白G(IgG)、血小板(BPC)、补体(C3、C4)、抗核抗体(ANA)阳性率、抗SSA抗体阳性率差异无统计学意义(P>0.05)。12例病情反复发作,其中男性2例(17%),女性10例(83%)。结论老年、男性、RF滴度高可能是RA并发ILD的危险因素;女性患者病情易反复,预后不佳;早期诊断和规范治疗可改善患者的预后。

Objective To analyze the clinical characteristics of patients of rheumatoid arthritis （RA） complicated with interstitial lung disease（ILD）. Methods The clinical symptoms,laboratory and imaging findings, and treatments of 322 admitted patients （ from Jun. 2009 to Jun. 2011 ）with RA were retrospectively analyzed. The patients were divided into two groups： RA -ILD group（ n = 39） and without ILD group （ n = 283 ）. Results The incidence rate of ILD in RA patients was 12% （39/322） and most of them （ 85 % ） were over 50 years old. In RA - ILD patients, the proportion of male were significantly higher than RA without ILD （ P 〈 0. 002） ; RA - ILD patients were older than those without ILD, and the difference was statistically significant （ P 〈 0. 000） ; furthermore, the levels of rheumatoid factor （RF） were significantly higher in RA -ILD patients than in without ILD group （P 〈0.013 ）. Tilere was no statistical difference of duration of disease, swollen joint counts, tender joint counts, erythrocyte sedimentation rate, C - reactive protein, anti - cyclic citrullinated peptide , antibody, immunoglobulin G, platelets, complement C3, C4, positive rate of antinuelear antibody and anti - SSA antibody between the RA patients with or without ILD group （P 〉 0.05）. There were 12 recurrent cases, including 2 males （17% , 2/12） and 10 females （83% , 10/12）. Conclusion It is suggested that older age, male, RF level may be the risk factors for ILD in RA patients. Recurrence and poor prognosis are often seen in women patients. Early diagnosis and standard treatment may improve the prognosis of RA with ILD patients.