结缔组织病合并间质性肺病重症感染预后因素分析

Prognostic factors of severe infection in connective tissue disease with interstitial lung disease

目的回顾分析结缔组织病(CTD)合并间质性肺病(ILD)重症感染的危险因素、死亡原因及治疗方法。方法回顾性分析2014年5月至2017年5月RICU收治的67例CTD合并ILD终末期患者,明确诊断为CTD,包括系统性红斑狼疮(SLE)、类风湿关节炎(RA)、多发性肌炎/皮肌炎(PM/DM)、系统性硬化病(SSC)、干燥综合征(p SS)等,分析ILD发生情况及临床资料、治疗及预后情况。结果 1.存活组与死亡组患者在临床症状、体征、合并基础病、影像学组间差异无统计学意义。临床症状两组均有发热、咳嗽、呼吸困难为主要表现,影像以网格、磨玻璃、蜂窝及实变为主要表现。2.两组实验室检查比较,死亡组患者Ig G、Ig A、Ig M水平明显高于存活组(P <0. 05)、死亡组患者氧合指数明显低于存活组(P <0. 05)。3.双因素logistic回归,结果示有创呼吸机通气和无创呼吸机通气是影响预后的独立预测因子。4.本实验中将积极治疗后入ICU,是否行无创呼吸机通气和有创呼吸机各分为两组,分别统计患者的生存期,以28天生存期为上界,生存曲线显示,应用有创呼吸机组患者的生存期为13. 1±1. 73天,未应用有创呼吸机患者的生存期为19. 1±2. 22天,两者具有显著差别(P=0. 003)。在无创呼吸机组,生存期无统计学意义(P> 0. 05)。结论 CTD合并ILD死亡组患者中Ig G、Ig A和Ig M显著升高,氧合指数明显降低,有创呼吸机通气和无创呼吸机通气是影响预后的独立预测因子,应用有创呼吸机患者的生存期明显低于未应用有创呼吸机组。建议患者CTD合并ILD终末期患者首先给予经鼻高流量吸氧,并尽量避免行有创机械通气和无创通气拖延抢救时机。

Objective To retrospectively analyze the risk factors,causes of death and treatment of connective tissue disease(CTD)complicated with interstitial lung disease(ILD).Methods A retrospective analysis was conducted on 67 patients with connective tissue disease complicated with ILD end-stage from May 2014 to May 2017 in RICU,including systemic lupus erythematosus(SLE),rheumatoid arthritis(RA),polymyositis/dermatomyositis(PM/DM),systemic sclerosis(SSC),and Sjogren's syndrome(pSS).The incidence of ILD and their clinical data and prognosis were analyzed.Results 1.There was no statistical significance between the survival group and the death group in clinical symptoms,signs,combined with basic disease and imaging.Their clinical symptoms of both groups were fever,cough,dyspnea as the main performance,and their images were to grid,ground glass,honeycomb and real as the main performance.The levels of IgG and IgA in the death group were significantly higher than those in the survivors group(P<0.05).The oxygenation index of the death group was significantly lower than that of the survivors group(P<0.05).3.The results of double-factor logistic regression showed that invasive ventilator ventilation and noninvasive ventilator ventilation were independent predictors of prognosis.In this study,the active treatment of ICU into the non-invasive ventilator ventilation and invasive ventilator were divided into two groups,respectively,and the survival of patients showed statistical difference.Taking 28-day survival for the upper bound,the survival curve showed that the application of survival time of patients with invasive ventilator was 13.1±1.73 days.The survival time of patients without invasive ventilator was 19.1±2.22 days(P=0.003).There was no significant difference in survival time between the noninvasive ventilator group and the invasive group(P >0.05).Conclusion In the death group of patients with CTD complicated with ILD,IgG,IgA and IgM increase significantly,and the oxygenation index decreased obviously.Invasive ventilator ventilation and non-invasive ventilator ventilation are independent predictors of prognosis.The survival time of patients with invasive ventilator is significantly lower than that of non invasive breathing units.It is suggested that CTD patients combined with ILD should be given high flow oxygen through nose at the end of the operation,and try to avoid invasive mechanical ventilation and non-invasive ventilation which may delay rescue time.