系统性红斑狼疮伴间质性肺炎的临床特点及相关因素分析

Clinical characteristics and related factors of systemic lupus erythematosus with interstitial pneumonia

目的:探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)伴间质性肺疾病(interstitial lung disease,ILD)患者的临床特点、影像评分及疾病相关危险因素。方法:收集2015年1月至2019年3月于包头医学院第一附属医院和台州市第一人民医院风湿免疫科住院且行肺高分辨率计算机断层扫描(high resolution computed tomography,HRCT)检查的60例SLE患者的临床资料,采用1∶1配比病例对照研究,两组患者年龄、性别匹配,其中SLE-ILD组的30例为病例组,SLE non-ILD(无ILD)组的30例为对照组。分析SLE-ILD患者的临床特点、影像学特征和肺HRCT评分,并分析SLE-ILD的相关危险因素。结果:两组相比,胸闷/气短、雷诺现象、Velcro啰音差异有统计学意义(P<0.05);SLE-ILD组比SLE non-ILD组患者的血红蛋白及白蛋白有明显下降趋势,而尿素氮、红细胞沉降率、C反应蛋白、IgG这4个指标有上升趋势,差异有统计学意义(P<0.05);SLE-ILD患者最常见的类型为非特异性间质性肺炎,依次为普通型间质性肺炎和淋巴细胞间质性肺炎;不同ILD分型的临床-影像-生理评分之间比较,差异无统计学意义(P>0.05);不同ILD分型的肺HRCT评分及肺功能之间比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,胸闷/气短、白蛋白下降是SLE-ILD发生的危险因素。结论:SLE患者出现胸闷/气短、低白蛋白血症要警惕ILD的发生,非特异性间质性肺炎是SLE-ILD最常见的表现类型。

Objective:To investigate the clinical features,radiologic scores and clinically relevant risk factors prognosis of secondary interstitial lung disease(ILD)in patients with systemic lupus erythematosus(SLE).Methods:In this study,60 SLE patients in Department of Rheumatology of the First Affiliated Hospital of Baotou Medical College and Taizhou First People’s Hospital from January 2015 to March 2019 were retrospectively analyzed.All of those 60 patients with SLE underwent lung high resolution computed tomography(HRCT)examination.We used a 1∶1 case-control study.There was a matching of age and gender between the two groups.Thirty patients with SLE related ILD(SLE-ILD)were in the case group,and 30 patients with SLE without ILE(SLE non-ILD)were in the control group.The clinical features,pulmonary function test,radiologic characteristic of SLE patients were collected and were used to analyze SLE-ILD.Results:In this study,we reached the following conclusions:First,there were statistically significant differences in chest tightness/shortness of breath,Raynaud’s phenomenon,and Velcro rale between SLE-ILD and SLE non-ILD patients(both P<0.05);Second,hemoglobin(Hb)and albumin(ALB)in the patients of SLE-ILD had a significant decrease compared with the patients of SLE non-ILD.Blood urea nitrogen(BUN),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)increased in SLE-ILD patients compared with SLE non-ILD patients,the difference had statistical significance(P<0.05);Third,for SLE-ILD patients,the most common type was non-specific interstitial pneumonia(NSIP),followed by usual interstitial pneumonia and lymphocytic interstitial pneumonia;Fourth,there was no significant difference in clinical-radiology-physiology scores between the different ILD types(P>0.05),similarly,the lung HRCT score and lung function between different ILD types had no significant difference(P>0.05);Fifth,multivariate Logistic regression analysis showed that decreased albumin and chest tightness/shortness of breath might be the risk factor for SLE-ILD.Conclusion:There are statistically significant differences between the SLE-ILD group and SLE non-ILD group in terms of chest tightness/shortness of breath,Velcro rale and Raynaud’s phenomenon.Decreased albumin and chest tightness/shortness of breath in SLE patients should be alerted to the occurrence of ILD.NSIP is the most common manifestation of SLE-ILD.