上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

结缔组织病合并肺疾病的临床研究

陈丽萍1，陈 颖1，于碧磬1，李芬宇1，史冉庚2，武丽君2   

  1. 新疆维吾尔自治区人民医院 1.呼吸与危重症医学科， 2.风湿免疫科， 乌鲁木齐 830001
  • 出版日期:2014-07-28 发布日期:2014-08-11
  • 作者简介:陈丽萍（1974—）， 女， 副主任医师， 硕士; 电子信箱: clp651@126.com。

Clinical study on connective tissue disease with pulmonary diseases

CHEN Li-ping1, CHEN Ying1, YU Bi-qing1, LI Fen-yu1, SHI Ran-geng2, WU Li-jun2   

  1. 1.Department of Respiratory and Critical Care Medicine, 2.Department of Rheumatology, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi 830001, China
  • Online:2014-07-28 Published:2014-08-11

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摘要：

目的 提高对结缔组织病（CTD）合并肺疾病的认识及诊断水平。方法 回顾性分析678例CTD患者呼吸系统的临床表现、肺功能及肺部影像学等特点，推断结缔组织病相关肺间质病变（CTD-ILD）患者肺部病变的病理类型。结果 678例CTD患者中，共117例（17.3%）合并肺疾病，病变主要出现在病程的（32.1±19.2）个月时，其中以肺部表现为首发症状者17例（2.5%）。CTD合并的肺疾病包括肺间质病94例（13.9%）、肺动脉高压11例（1.6%）、胸腔积液46例（6.9%）、胸膜增厚6例（0.9%）和感染6例（0.9%）。CTD-ILD的主要呼吸系统症状为干咳（63.8%）、呼吸困难（43.6%）、胸痛（13.8%）及咯血（2.1%）。其中62.8%的患者临床表现为慢性型，36.2%为无症状型，仅在皮肌炎/多肌炎中有1例急性型。依据高分辨电子计算机断层扫描（HRCT）推断CTD-ILD的病理类型：非特异性间质性肺炎占70.2%，脱屑性间质性肺炎占17.0%，寻常型间质性肺炎占9.6%。结论 CTD患者较多合并肺疾病，其中以CTD-ILD最为多见。合并肺疾病的患者呼吸系统临床表现多不典型，HRCT对诊断CTD-ILD及其病理类型的推断有一定的价值。

关键词: 结缔组织病, 肺疾病, 肺间质病变, 临床表现, 高分辨电子计算机断层扫描

Abstract:

Objective To improve the awareness and diagnosis of connective tissue disease (CTD) with pulmonary diseases. Methods The clinical manifestations of the respiratory system, pulmonary function, and characteristics of lung imaging of 678 patients with CTD were retrospectively analyzed. The pathological types of pulmonary lesions of patients with interstitial lung disease associated with connective tissue disease (CTDILD) were determined. Results Among 678 patients with CTD, 117 patients (17.3%) were with pulmonary diseases. Pulmonary diseases mainly occurred in the course of (32.1±19.2) months. The first symptom of 17 cases (2.5%) was pulmonary manifestations. Pulmonary diseases associated with CTD included interstitial lung disease (94 cases, 13.9%), pulmonary hypertension (11 cases, 1.6%), pleural effusion (46 cases, 6.9%), pleural thickening (6 cases, 0.9%), and infection (6 cases, 0.9%). The primarily respiratory symptoms of CTD-ILD were dry cough (63.8%), dyspnea (43.6%), chest pain (13.8%), and hemoptysis (2.1%). The clinical manifestations of 62.8% of patients were chronic; 36.2% were asymptomatic; and only one (with dermatomyositis/polymyositis) was acute. According to the high-resolution computed tomography (HRCT), pathological types of CTD-ILD were non-specific interstitial pneumonia (70.2%), desquamative interstitial pneumonia (17.0%), and usual interstitial pneumonia (9.6%). Conclusion CTD is often associated with pulmonary diseases and the most common one is CTD-ILD. The clinical manifestations of the respiratory system of most CTD patients with pulmonary diseases are not typical. HRCT is helpful for the diagnosis of CTD-ILD and determination of its pathological types.

Key words: connective tissue disease, pulmonary disease, interstitial lung disease, clinical manifestations, high-resolution computed tomography