结缔组织病相关间质性肺病和特发性肺纤维化临床特征比较

Comparison of characteristics of connective tissue disease-associated interstitial lung diseases and ;idiopathic pulmonary fibrosis

目的：比较结缔组织病相关间质性肺病（CTD-ILD）与特发性肺纤维化（IPF）的临床特征。方法收集2014年6月至2015年12月诊断为间质性肺病的住院患者，同时排除已知其他原因导致的间质性肺病患者。回顾性分析患者临床表现、自身抗体、影像学、血气分析等特征。结果总共纳入628例患者，其中CTD-ILD患者459例（73.09%），IPF患者169例（26.91%）。CTD-ILD 组和 IPF 组年龄分别为（52.10±14.23）岁和（67.10±13.13）岁，差异有统计学意义（t＝-10.092，P＝0.000）。IPF 组患者男性比例明显高于 CTD-ILD 组[75.15%（127/169）比28.32%（130/459），P＝0.000]。CTD-ILD患者自身抗体多种阳性，IPF患者部分可见抗核抗体、抗干燥综合征抗原A抗体和抗Ro-52抗体阳性。IPF患者胸部高分辨CT以蜂窝状影、肺大疱、肺气肿等纤维化表现多见，而CTD-ILD患者则以实变影、小结节影等炎性表现为主。IPF组呼吸衰竭发生率显著高于 CTD-ILD 组[49.11%（83/169）比13.07%（60/459）]，差异有统计学意义（P＜0.01）。结论 CTD-ILD和IPF患者临床特征完全不同，对ILD患者进行临床表现、自身抗体、胸部高分辨CT等全面评估，有利于我们对ILD的认识及合理诊治。

Objective To compare the characteristics of connective tissue disease-associated interstitial lung disease （CTD-ILD） and idiopathic pulmonary fibrosis（IPF）. Methods Patients with a diagnosis of ILD from June 2014 to December 2015 were selected in this study and patients with known other causes of ILD were excluded. The clinical manifestation, autoantibody, high resolution chest computed tomography （CT） and blood gas analysis were retrospectively analyzed. Results Six hundred and twenty-eight patients were included in this study. The prevalence of CTD-ILD and IPF were 459 （73.09%） and 169（26.91%） respectively. The age in IPF group was higher than that in CTD-ILD group：（67.10 ± 13.13） years vs. （52.10 ± 14.23） years, and there was significant difference （t =-10.092, P =0.000）. The rate of male in IPF group was higher than that in CTD-ILD group： 75.15%（127/169） vs. 28.32%（130/459）, and there was significant difference （P=0.000）. Autoantibodies were commonly seen in CTD-ILD group and only antinuclear antibody, and anti-SSA antibody and anti-Ro-52 antibody were seen in IPF group. The most common chest images were honeycombing, bullae of lung and pneumonectasis in CTD-ILD group, while the presence of consolidation and small nodular shadow were more common in IPF group. The concurrence of respiratory failure was higher in IPF group compared with that in CTD-ILD group：49.11%（83/169） vs. 13.07%（60/459）, and there was significant difference （P〈0.01）. Conclusions Patients with CTD-ILD and IPF possess distinct characteristics. Overall assessment＆nbsp;of clinical manifestation, autoantibody serology, high resolution chest CT and other indicator will be conducive to the differential diagnosis and treatment of ILD.