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

117例类风湿关节炎患者肺间质病变临床特点及危险因素研究

陈慕芝1，付强2，扶琼3，杨程德4，李挺3   

  1. 1.新疆医科大学附属中医医院风湿科， 乌鲁木齐 830099； 2.江西省人民医院风湿科， 南昌 330006； 3.上海交通大学 医学院附属仁济医院风湿科， 上海  200127； 4.上海交通大学 医学院附属瑞金医院风湿科， 上海 200025
  • 出版日期:2016-03-28 发布日期:2017-06-02
  • 通讯作者: 李挺, 电子信箱: leeting007@163.com。
  • 作者简介:陈慕芝（1982—）， 主治医师， 硕士; 电子信箱: 2545783453@qq.com。
  • 基金资助:

    新疆维吾尔自治区自然科学基金项目（2014211C021）

Study on clinical characteristics and risk factors of interstitial lung disease in 117 patients with rheumatoid arthritis

CHEN Mu-zhi1, FU Qiang2, FU Qiong3, YANG Cheng-de4, LI Ting3   

  1. 1.Department of Rheumatology, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830099, China； 2.Department of rheumatology, Jiangxi Peoples Hospital, Nanchang 330006, China; 3.Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 4.Department of Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2016-03-28 Published:2017-06-02
  • Supported by:

    Natural Science Foundation of Xinjiang Autonomous Region grant， 2014211C021

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摘要：

目的 评估类风湿关节炎（RA）合并肺间质病变（ILD）患者的临床特点、影像学检查及实验室检查，并研究类风湿关节炎合并肺间质病变（RA-ILD）的相关危险因素。方法 回顾2010年7月至2011年7月在上海交通大学医学院附属仁济医院风湿科住院的RA患者，比较RA有ILD组（RA-ILD组）及RA无ILD组患者的年龄、性别、病程、主动吸烟、被动吸烟、用药史及类风湿因子（RF）、抗环瓜氨酸肽抗体（CCP）等指标，分析RAILD发生的相关危险因素。并采用国际上通用的评分系统量化肺部高分辨CT（HRCT）表现的方法对肺部HRCT进行评分，评估RA-ILD的严重程度，分析上述指标与RA-ILD严重程度的相关性。结果 117例RA患者，男性32例，女性85例；其中35例合并ILD（29.9%，35/117）。RA-ILD组中54.3%（19/35）有呼吸道症状。RA-ILD组患者年龄、起病年龄均明显高于RA无ILD组（P=0.000 4，P=0.000 08）；RA-ILD组主动吸烟患者、被动吸烟患者比例均明显高于RA无ILD组（P=0.001，P=0.005），主动吸烟与被动吸烟是RA-ILD的独立危险因素。男性RA患者ILD程度较女性严重（P=0.023 6）；男性RA患者出现ILD的时间早于女性（P=0.011 3）；起病年龄越大，发生ILD越快（P=0.004 2，r=-0.472 0）；抗CCP抗体阳性RA患者ILD程度倾向于较抗CCP抗体阴性者严重（P=0.055 3）。ILD严重程度与既往是否使用甲氨蝶呤、来氟米特无关（P＞0.05）。结论 首次发现被动吸烟是RA发生ILD的独立危险因素；约半数RA-ILD患者呼吸道症状轻微，应及时行肺部HRCT检查以早期诊断；RA-ILD患者中，老年、男性、抗CCP抗体阳性者预示病情较严重，应给予足够的重视。

关键词: 类风湿关节炎, 肺间质病变, 计算机断层扫描, 高分辨率, 危险因素

Abstract:

Objective To assess clinical characteristics, imaging and laboratory examinations for rheumatoid arthritis (RA) patients combined with interstitial lung disease (RA-ILD) and investigate related risk factors in RA-ILD. Methods Clinical data of 117 RA inpatients admitted by the Department of Rheumatology of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between July 2010 and July 2011 were retrospective analyzed. Clinical indexes such as age, gender, course of disease, history of active or passive smoking, medicine history, rheumatoid factors (RF), as well as anti-cyclic citrullinated peptide antibody (CCP) between RA group and RA-ILD group were compared and risk factors related to RA-ILD were analyzed. Lung high resolution CT (HRCT) images of RA-ILD patients were scored by using an international recognized scoring system to assess the severity of ILD. Correlations between the severity of ILD and above indexes were analyzed. Results Among 117 RA patients, 32 were males and 85 were females. 35 patients were diagnosed with RA-ILD (29.9%, 35/117). 4.3% (19/35) of patients had respiratory symptoms in the RA-ILD group. Ages and RA onset ages in the RA-ILD group were significantly older than those in the RA group (P=0.000 4, P=0.000 08). Proportion of active or passive smoking patients in the RA-ILD group was significantly higher than that in the RA group (P=0.001, P=0.005). Active smoking and passive smoking were independent risk factors in RA-ILD. The severity of ILD in male RA patients was greater than that in female RA patients (P=0.023 6). The onset of ILD was earlier in male RA patients compared with female RA patients (P=0.011 3). The older the RA onset age was, the quicker the development of ILD would be (P=0.004 2, r=-0.472 0). The severity of ILD in RA patients positive for anti-CCP antibody tended to be greater compared with RA patients negative for anti-CCP antibody (P=0.055 3). The severity of ILD was not associated with previous methotrexate or leflunomide administration (P>0.05). Conclusion We found, for the first time as far as we know, that passive smoking is an independent risk factor for ILD development in RA patients. Given that about half of RA-ILD patients only have slight respiratory symptoms, it is important to perform lung HRCT examination in order to achieve early diagnosis. Old age, male and positive for anti-CCP antibody in RA-ILD patients indicate more severe ILD and adequate attention should be paid to them.

Key words: rheumatoid arthritis, interstitial lung disease, computed tomography, highresolution, risk factor