类风湿关节炎合并肺间质纤维化的临床特点

Clinical characteristics of rheumatoid arthritis combined with interstitial pulmonary fibrosis

目的探讨类风湿关节炎(RA)合并肺间质纤维化(IPF)患者的临床特点及其相关因素。方法系统性回顾88例RA合并IPF患者(观察组)的临床表现、实验室指标及影像学检查,并与113例单纯RA患者(对照组)相比较。结果观察组患者均为高分辨率CT(HRCT)提示肺间质改变,包括网状影、磨玻璃影、蜂窝肺、胸膜肥厚等;其中有干咳症状者18例(20.5%),有胸闷、气促症状者11例(12.5%),有呼吸困难者22例(25.0%),有Velcro啰音者23例(26.1%)。观察组患者年龄、病程、血清C反应蛋白水平、抗环瓜氨酸肽(CCP)抗体滴度、类风湿因子(RF)滴度均显著高于对照组(P<0.01),补体3水平显著低于对照组(P<0.05)。2组患者关节肿胀数、关节压痛数、血红细胞沉降率、补体4水平、口干、眼干、抗角蛋白抗体阳性、抗核抗体阳性、抗干燥综合征抗体阳性、抗干燥综合征抗体阳性比较差异均无统计学意义(P>0.05)。结论 RA合并IPF患者年龄较大、病程较长,但临床症状轻微,应尽早完善肺HRCT检查,以便早期诊断和治疗。高滴度抗CCP抗体、RF可能与RA合并IPF相关。

Objective To analyze the clinical characteristics and related factor of interstitial pulmonary fibrosis（IPF） in patients with rheumatoid arthritis（RA）. Methods A total of 88 RA patients combined with IPF and 113 cases without IPF were retrospectively analyzed. Characteristics of RA-IPF in clinical, lab and chest high-resolution computed tomography （HRCT） data were analyzed, and were compared between the patients with and without IPF. Results All of the RA-IPF pa- tients had HRCT and indedcted lung mesenehymal change,including reticulation, ground glass opacity, honeycombing, hyper- trophic pleura and so on. Eighteen（20.5% ） patients had cough symptom, 11 （ 12.5% ） patients had tight chest and shortness of breath ,22 （25.0%）patients had expiratory dyspnea,23 （26.1% ）patients had Velcro rales. The age, course of disease, the titer of anti-cyclic citrullinated peptide,the titer of rheumatoid factor （RF） and C-reactive protein （CRP） of RA-IPF patients were significantly higher than those of patients without IPF （P 〈 O. O1 ）, but the complement 3 of RA-IPF patients were significantly lower than that of patients without IPF（P 〈 O. 05 ）. No difference of joint swelling count ,joint tenderness count, erythrocyte sedi- mentation rata, complement 4, dryness of month and eye, the positive of anti-keratin autibodier, anti-nuclear antibody, anti-sjogren＇ s syndrome A antibody and anti-sjogren＇s syndrome B antibody between the two groups （P 〉 0. 05 ）. Conclusion RA patients with IPF is more common in older and had longer duration patients,but the clinical symptoms are mild. HRCT provides a useful tool for early diagnosis and treatment. High titer anti-CCP and RF might be important associated with RA-IPF.