炎症性肠病相关呼吸系统疾病12例临床特征分析

Clinical features of 12 cases of respiratory diseases associated with inflammatory bowel diseases

目的总结炎症性肠病（IBD）相关呼吸系统疾病的临床特征，加深临床医生对该病的认识。方法回顾性分析2011年1月至2017年5月首都医科大学附属北京朝阳医院收治的12例IBD相关呼吸系统疾病患者的临床资料。结果12例中，男11例，女1例，年龄37～75岁，平均（61±12）岁，其中吸烟者6例（均未戒烟）。溃疡性结肠炎11例，克罗恩病1例。诊断IBD至出现呼吸系统疾病的间隔时间为5个月至30年。12例确诊相关呼吸系统疾病时均未进行IBD治疗，其中支气管扩张症3例，间质性肺疾病5例（2例经病理诊断为机化性肺炎），肺栓塞3例，肺动脉狭窄闭塞1例。9例以呼吸系统症状就诊，临床表现无明显特异性，以咳嗽、咳痰及呼吸困难常见。1例以腹部症状就诊，2例为体检时发现。胸部CT表现与呼吸系统受累情况相关，表现为支气管扩张、肺部网格影、斑片状影和肺动脉充盈缺损等。结论IBD相关呼吸系统疾病临床表现多样，可累及气道、肺间质和肺血管，多在IBD诊断数年后出现。溃疡性结肠炎较克罗恩病更易累及呼吸系统。

Objective To investigate the clinical features of respiratory diseases associated with inflammatory bowel diseases （IBD）. Methods A retrospective analysis was performed for 12 cases of respiratory diseases associated with IBD admitted to Beijing Chaoyang Hospital from January 2011 to May 2017. Their clinical data, including symptoms, laboratory, spirometry, radiological findings as well as therapy and clinical course, were collected. Results These 12 patients, including 11 males and 6 smokers, were 37 -75 years old, with an average age of （61 ± 12） years. There were 11 patients with ulcerative colitis（UC） and 1 with Crohn＇s disease（CD）. The interval between the diagnosis of IBD and the occurrence of respiratory diseases ranged from 5 months to 30 years. The patients did not receive therapy for IBD when respiratory diseases were diagnosed. The respiratory diseases associated IBD included bronchiectasis （ n = 3 ） , interstitial lung diseases （ n = 5, with 2 cases of organizing pneumonia by pathology） , pulmonary embolism （ n = 3 ） and pulmonary arterial stenosis （ n = 1 ）. Of the 12 cases, 9 presented with respiratory symptoms, including cough, expectoration and dyspnea. One patient presented with abdominal symptoms and 2 cases were found by physical examinations. Chest CT features were manifested as bronchiectasis, reticular patterns, patchy opacity and pulmonary artery filling defect. Conclusions Respiratory diseases associated with IBD are various, which can involve airways, interstitium and pulmonary vessels. Respiratory diseases seem to be more common in patients with UC as compared to those with CD.