RA-ILD与临床和实验室指标相关性研究

Clinical and laboratory correlation study of rheumatoid arthritis combined with interstitial lung disease

目的收集类风湿关节炎合并肺间质病变(RA-ILD)患者的相关临床指标、实验室指标和肺部影像学表现等临床资料,分析这些因素与RA-ILD的发生和发展的关系,为RA-ILD的诊疗提供一定的临床依据。方法回顾性收集2014年1月-2015年1月在新疆维吾尔自治区人民医院风湿免疫科住院的RA患者,一般资料、临床表现、实验室指标和影像学检查。结果 1 204例RA患者中44例发生ILD,占21.6%。6例胸闷、气短;6例有咳嗽、咳痰;6例听诊有Velcro音。比较发现RA-ILD组咳嗽咳痰、胸闷气短、Velcro音的发生率高于单纯RA组(P<0.05)。RA-ILD组患者肺HRCT最常见的表现是磨玻璃影。2 RA-ILD组的平均病程、年龄明显大于单纯RA组(P<0.05)。3 RA-ILD组白细胞、血红蛋白、血小板、DAS28、ESR、CRP、C3、C4、RF、GPI较单纯RA组差异无统计学意义(P>0.05)。4 RA-ILD组抗CCP抗体滴度显著大于单纯RA组(P<0.05)。5比较两组AKA阳性率差异有统计学意义(P<0.05),而抗SSA抗体阳性率、抗核抗体阳性率差异无统计学意义(P>0.05)。结论 RA-ILD患者年龄大、平均病程长,大部分临床表现不明显,需及时完善HRCT,早期诊断和治疗。高抗CCP抗体滴度、ANA阳性可能与RA-ILD的发生相关。

Objective To analyze the relationship between these factors and occurrence and development of RA-ILD by collecting the relevant clinical and laboratory data of rheumatoid arthritis with interstitial lung disease（ RA-ILD） patients. Methods The clinical data of hospitalized patients with RA from January 2014 to January 2015 were retrospectively analyzed,including its population information,clinical manifestation,laboratory and imaging examination. Results（ 1） 44 cases occurred with RA-ILD in 204 patients,accounting for 21. 6%. There were 6 cases of chest tightness and shortness of breath,6 cases of cough and sputum,and 6 cases with Velcro rales. Compared the RA-ILD group,the incidence of Velcro sound was higher than patients without ILD（ P〈0. 05）. One of the most common HRCT of the lung in the RA-ILD group was ground glass shadow.（ 2） The average duration and age of the RA-ILD group were significantly greater than those of the RA group（ P〈0. 05）.（ 3） There was no significant difference in white blood cells,hemoglobin,platelet,DAS28,ESR,CRP,C3,C4,RF and GPI between the two groups（ P〉0. 05）.（ 4） The level of anti-CCP was significantly higher in the RA-ILD group than in the RA group（ P〈0. 05）.（ 5） The positive rate of anti-AKA and anti-nuclear antibody showed statistical significance（ P〈0. 05）,but there was no significant difference in anti-SSA antibody（ P〉0. 05）. Conclusion RA patients with ILD are more common with elderly age and longer average duration,but most of the clinical symptoms is not obvious. HRCT can provide a useful tool for early diagnosis and treatment in time. High titer anti-CCP,AKA positive,positive ANA may be associated with the occurrence of RA-ILD.