干燥综合征并发间质性肺疾病患者临床特征及其危险因素分析

Analysis on clinical characteristics and risk factors of patients with Sjogren’s syndrome complicated with interstitial lung disease

目的:分析原发性干燥综合征(pSS)并发间质性肺疾病(ILD)患者临床特征和危险因素,提高对该疾病的认识,为临床医生早期发现腺外器官受累提供依据。方法:收集176例pSS患者的临床资料,按照是否并发ILD分为pSS并发ILD组(n=21)和pSS未并发ILD组(n=155),比较2组患者血红蛋白(Hb)、白细胞(WBC)、血小板(PLT)、C反应蛋白(CRP)、红细胞沉降率(ESR)、类风湿因子(RF)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、补体3(C3)和补体4(C4)水平及颗粒型抗核抗体、胞浆颗粒型抗核抗体、均质型抗核抗体、抗SSA抗体、抗SSB抗体和抗Ro-52抗体阳性率。单因素和多因素Logistic回归分析pSS并发ILD患者的临床特征和实验室检查指标。结果:176例pSS患者中男女比例为1∶28,中位年龄为49(39~58)岁,中位病程为24(24~48)个月。与pSS未并发ILD组比较,pSS并发ILD组患者年龄明显增加(P<0.01),ESR水平、胞浆颗粒型抗核抗体和抗Ro-52抗体阳性率明显升高(P<0.01)。多因素Logistic回归分析,ESR水平升高(OR=1.046,95%CI:1.026-1.066,P=0.001)和胞浆颗粒型抗核抗体阳性(OR=4.676,95%CI:1.156-18.916,P=0.031)为pSS并发ILD的危险因素。结论:pSS并发ILD患者发病年龄较大且ESR水平较高,胞浆颗粒型阳性和抗Ro-52抗体阳性者可能更易并发ILD,ESR水平升高和胞浆颗粒型抗核抗体阳性是pSS并发ILD的危险因素。

Objective:To analyze the clinical characteristics and risk factors of the patients with primary Sjogren’s syndrome(pSS)complicated with interstitial lung disease(ILD),and to improve the clinicians’understandings of the disease,and to provide the evidence for the early detection of extradular organ involvement by the clinicians.Methods:The clinical characteristics of 176 patients with pSS were collected and were divided into pSS complicated with ILD group(n=21)and pSS complicated without ILD group(n=155)according to whether the patients were complicated with ILD.The levels of hemoglobin(Hb),white blood cells(WBC),platelets(PLT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),immunoglobulin G(IgG),immunoglobulin M(IgM),immunoglobulin A(IgA),complement 3(C3),complement 4(C4),and the positive rates of granular type antinuclear antibodies,cytoplasmic granular type antinuclear antibodies,homogeneous type antinuclear antibodies,anti-SSA,anti-SSB,and anti-Ro-52 antibodies of the patients in two groups were compared.Univariate and multivariate Logistic regression analysis were used to analyze the clinical characteristics and laboratory indexes of the pSS patients complicated with ILD.Results:Among the 176 pSS patients,the ratio of male to female was 1∶28,with the median age of 49(39-58)years and the median course of 24(24-48)months.Compared with pSS complicated without ILD group,the age of the patients in ILD group was older(P<0.01),and the level of ESR was increased(P<0.01),the positive rates of cytoplasmic granular type antinuclear antibody and anti-Ro-52 antibody were increased(P<0.01).The multivariate Logistic regression analysis results showed that the increasing of ESR level(OR=1.046,95%CI:1.026-1.066,P=0.001)and positive granulosa type(OR=4.676,95%CI:1.156-18.916,P=0.031)were the risk factors for ILD complicated with pSS.Conclusion:The patients with pSS complicated by ILD have an older onset age and higher ESR levels;ILD is more likely to occur when the cytoplasmic granular type antinuclear antibody and anti-Ro-52 antibody of the patients are positive;the increasing of the ESR level and positive coated granular type antinuclear antibody are the risk factors for the pSS complicated with ILD.