强直性脊柱炎患者肺部受累的临床特征及相关因素分析

Clinical features of pulmonary damage in ankylosing spondylitis patients and related factors

目的初步探讨强直性脊柱炎（AS）患者出现肺部受累的临床特征，为分析肺部受累相关因素提供依据。方法选取在我院诊断AS患者185例，根据肺高分辨CT（HRCT）结果，分成肺部受累组108例，无肺部受累组77例，采用t检验、χ2检验对两组间各临床及实验室指标、影像学检查进行比较，对因素进行Logistic回归分析，确定肺部受累的危险因素。结果①185例AS患者出现肺部受累者108例，比例达58．4％。②肺部受累组发病年龄大于无肺部受累组（P〈0．05），同时病程时间远长于无肺部受累组（P〈0．01）。肺部受累组仅16．7％的患者临床出现呼吸系统症状，较之无肺部受累组呼吸症状发生率高，临床可出现干咳、胸闷等症状，比较差异无统计学意义。③肺部受累组在HRCT上主要表现为不同程度的肺间质病变、肺叶纤维灶，其他表现为淋巴结肿大、胸膜增厚、肺大泡、肺气肿、支气管扩张等改变。④实验室检查发现肺部受累组球蛋白升高、血清IgG增高者明显高于无肺部受累组（P〈0．01）。影像学检查发现肺部受累的发生与骶髂关节炎的严重程度有关，肺部受累组AS患者的骶髂关节炎症临床多处于Ⅲ～Ⅳ级，病变较重。Logistic回归分析提示，年龄、血清IgG增高及骶髂关节病变程度为AS患者合并肺部受累的相关因素。结论AS患者出现肺部受累并不少见，肺高分辨CT可作为早期发现肺部受累的主要检查方法，发病年龄晚、病程较长、球蛋白水平高及IgG增高、骶髂关节病变较重的AS患者更易出现肺部受累，高龄及血清IgG增高、骶髂关节炎症严重程度（≥Ⅲ级）是AS患者发生肺部受累的相关因素。

Objective To study the clinical features of pulmonary damage in ankylosing spondylifts （AS） patients and explore the related factors. Methods Analysis was made in 185 patients diagnosed with AS in our hospital, who were divided into pulmonary damage group （group A） and non pulmonary damage group（group B） according to the chest high resolution CT（HRCT） presentation. T-test and Chisquare test were applied to compare the clinical manifestations, laboratory results and radiological examination between group A and B. A univariate analysis and multivariate logistic regression analysis were carried out to evaluate the risk factors related to pulmonary damage in AS. Results ①One hundred and eight patients had pulmonary damage（58.4%）. ②The age of patients in group A was older than that of group B （ P 〈0.05）, at the same time,disease course was much longer than that of group B （ P〈 0.01）. 16.7%of patients in group A had respiratory symptoms, such as dry cough, chest tightness, which were more common than those of group B,but dry cough and chest tightness had no significant difference between two groups. ③ In group A, the main findings in HRCT were interstitial lung disease, lung fibrosis, other characterized by swollen lymph nodes, pleural thickening, pulmonary bullae, emphysema and bronchiectasis. ④The level of globulin increased and increased serum IgG was significantly different between group A and B （ P 〈0.01）. In group A, the severity of sacroiliac joint arthritis was most clinical stage Ⅲ-IV level, and the condition was heavier than that of group B. Multivariate logistic regression analysis suggested that age, increased serum IgG and the severity of sacroiliac joint arthritis were related factors for pulmonary damage in AS patients. Conclusion The pulmonary damage is common in AS patients. Age, increased serum IgG and sacroiliac joint arthritis（≥Ⅲ level） are the risk factors contributing to pulmonary damage in AS patients.