结缔组织疾病相关间质性肺病并发小气道功能障碍临床分析

Clinical analysis of interstitial lung disease associated with connective tissue disease complicated with small airway dysfunction

目的分析结缔组织疾病相关间质性肺病(connective tissue disease⁃associated interstitial lung disease,CTD⁃ILD)并发小气道功能障碍的临床特征、影像学分型及肺功能特点。方法选择2020年1月至2023年6月我院收治的245例CTD⁃ILD患者。CTD⁃ILD并发小气道功能障碍(small airway dysfunction,SAD)86例为观察组和未并发SAD 159例为对照组,比较两组基线资料、影像学分型及肺功能。结果观察组干燥综合征14例(48.28%)、系统性红斑狼疮3例(37.50%)、系统性血管炎5例(38.46%)、重叠综合征17例(36.96%)少于对照组干燥综合征15例(51.72%)、系统性红斑狼疮5例(62.50%)、系统性血管炎8例(61.54%)、重叠综合征29例(63.04%),两组年龄、性别、体质量指数等差异无统计学意义(P>0.05)。观察组肺动脉高压15例(17.44%)高于对照组14例(8.81%),观察组合并冠心病3例(3.49%)、脑梗死2例(2.33%)低于对照组合并冠心病17例(10.69%)、脑梗死26例(16.35%)(P<0.05)。对照组影像学分型为非特异性间质性肺炎(nonspecific interstitial pneumonia,NSIP)84例(52.83%)高于观察组32例(37.21%)(P>0.05)。观察组用力肺活量(forced vital capacity,FVC)占预计值%(72.60±19.30)%、第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))占预计值%(68.38±16.35)%、FEV_(1)/FVC(78.94±7.80)、肺一氧化碳弥散量(diffusing capacity of the lungs for carbon monoxide,DLCO)占预计值%(47.28±16.93)%较对照组(87.14±19.47)%、(91.56±19.13)%、(87.25±5.21)、(57.03±17.11)%差,观察组残总比(RV/TLC)43.00(38.00,47.25)较对照组39.00(35.00,43.00)高(P<0.05)。观察组间质性肺病⁃性别⁃年龄⁃生理(interstitial lung disease⁃gender⁃age⁃physiology,ILD⁃GAP)分期高。结论系统性红斑狼疮、干燥综合征、系统性血管炎、重叠综合征类型的CTD⁃ILD易并发SAD,易患肺动脉高压,肺功能指标差,ILD⁃GAP分期高。

Objective To analyze the clinical features,imaging patterns and pulmonary function of connective tissue disease-associated interstitial lung disease(CTD-ILD)complicated with small airway dysfunction.Methods All of 245 cases of CTD-ILD patients admitted to our hospital from January 2020 to June 2023 were selected.86 cases of CTD-ILD complicated with small airway dysfunction(SAD)were treated as the observation group and 159 cases without SAD as the control group.The baseline data,radiographic characteristics and pulmonary function of the two groups were compared.Results In the observation group,14 cases of sjogren′s syndrome(48.28%),3 cases of systemic lupus erythematosus(37.50%),5 cases of systemic vasculitis(38.46%)and 17 cases of overlapping syndrome(36.96%)were less than those in the control group(15 cases of Sjogren′s syndrome(51.72%)).There were 5 cases of systemic lupus erythematosus(62.50%),8 cases of systemic vasculitis(61.54%)and 29 cases of overlap syndrome(63.04%).There was no significant difference in age,sex and body mass index between the two groups(P>0.05).In the observation group,15 cases of pulmonary hypertension(17.44%)were higher than that in the control group(8.81%),3 cases of coronary heart disease(3.49%)and 2 cases of cerebral infarction(2.33%)were lower than that i 17 cases of coronary heart disease(10.69%)and 26 cases of cerebral infarction(16.35%)n the control group(P<0.05).84 cases of nonspecific interstitial pneumonia(NSIP)in the control group(52.83%)were higher than 32 cases of NSIP in the observation group(37.21%)(P>0.05).In the observation group,forced vital capacity(FVC)accounted for(72.60±19.30)%and forced expiratory volume in one second FEV_(1)% accounted for(68.38±16.35)%,FEV_(1)/FVC(78.94±7.80)and diffusing capacity of the lungs for carbon dioxide of expected monoxide(DLCO)(47.28±16.93)%is lower than that of control group(87.14±19.47)%,(91.56±19.13)%,(87.25±5.21),(57.03±17.11)%.The residual total ratio(RV/TLC)in the observation group was 43.00(38.00,47.25)higher than that in the control group 39.00(35.00,43.00)(P<0.05).The stages of interstitial lung disease-gender-age-physiology(ILD-GAP)were observed.Conclusion CTD-ILD patients with systemic lupus erythematosus,Sjogren′s syndrome,systemic vasculitis and overlapping syndrome are prone to SAD,pulmonary hypertension,poor pulmonary function index and high ILD-GAP stage.