目的：探讨类风湿关节炎（rheumatoid arthritis，RA）伴间质性肺病（interstitial lung disease，ILD）患者临床表现、肺部高分辨率 CT 及实验室指标的特点，分析单纯 RA 患者与 RA 合并 ILD 患者临床特点的差异，为临床诊治提供依据。方法回顾性分析中国医科大学附属第一医院风湿免疫科住院 RA 患者470例，根据肺部高分辨率 CT 结果分为 RA-ILD 组和单纯 RA 组。比较两组患者的一般情况、临床表现以及实验室指标。结果共纳入 RA 患者470例，RA-ILD 组163例，单纯 RA 组307例。RA-ILD 组患者在年龄[（63±12）岁比（55±13）岁]、发病年龄[（55±14）岁比（48±14）岁]、病程[（88±92）个月比（78±86）个月]均高于单纯 RA 组，差异有统计学意义（均 P ＜0．05）。RA-ILD 组患者的关节肿痛（关节数）（85．9％比63．6％）、咳嗽咯痰胸痛（11．0％比1．9％）、活动后气短（16．6％比5．5％）发生率均高于单纯 RA 组。RA-ILD组限制性通气功能障碍（22．9％比11．1％）、弥散功能减低（35．4％比16．7％）发生率显著高于单纯 RA-ILD 组。RA-ILD 组抗核抗体阳性率（38．2％比45．1％）高于单纯 RA 组，差异有统计学意义（均 P ＜0．05）。RA-ILD 组纤维蛋白原[（5．59±3．04）g/L 比（5．14±2．50）g/L）]、类风湿因子[（704．90±1326．64）U/ml 比（389．42±669．15）U/ml]、C-反应蛋白[（56．70±56．07）mg/L 比（45．71±52．64）mg/L]、免疫球蛋白 A 水平[（3．62±1．74）g/L 比（3．21±1．50）g/L]均高于单纯RA 组；而血清白蛋白水平[（42．35±5．17）g/L 比（43．89±6．03）g/L]低于单纯 RA 组，差异有统计学意义（均 P ＜0．05）。结论年龄较大、病程较长、关节炎性明显的 RA 患者易合并 ILD，而且纤维蛋白原、C 反应蛋白、血尿素氮、C-胱抑素肽、血清白蛋白、外周血白细胞计数、中性粒细胞计数、α1-球蛋白、α2-球蛋白等临床指标持续异常可能与 RA 患者 ILD 发生发展有关，均可作为 RA 伴发 ILD 的预测因素，同时肺部高分辨率 CT、肺弥散功能对早期发现病变有诊断意义，对于 RA患者的治疗和预后有重要价值。%Objective To investigate the clinical features of rheumatoid arthritis associated interstitial lung disease, and to find out clinical differences between uncomplicated rheumatoid arthritis and rheumatoid arthritis associated ILD in order to provide hints for early clinical recognization.Methods We analyzed 470 inpatients with RA retrospectively in the Department of Rheumatology and Immunology the First Affiliated Hospital of China Medical University.470 RA patients were divided into RA-ILD group (n =163)and uncomplicated RA group (n =307)according to results of pulmonary HRCT.We compared the clinical data of RA patients with and without ILD respectively.SPSS was used to carry out statistical analysis for this study.Result Participants included 470 cases of RA patients,163 cases in RA -ILD group,307 cases in uncomplicated RA group.Age [(63 ±12)years vs.(55 ±13)years],age at onset [(55 ±14)years vs.(48 ±14)years]and disease duration [(88 ±92)months vs.(78 ±86)months]in the RA-ILD group were higher than these of uncomplicated RA group significantly (P <0.05).Symptoms such as joint swelling (85.9% vs.63.6%)and pains,cough、expectoration with chest pain (11.0% vs.1.9%)and short of breath (16.6% vs.5.5%)after exertion were more in RA-ILD group than these in the uncomplicated group.The frequency of restrictive ventilation dysfunction (22.9% vs.11.1%)and decrease of diffuse function(35.4% vs.16.7%)wasmuch higher in the RA-ILD group that that of uncomplicated RA group.Positive rate of ANA (38.2% vs.45.1%)in the RA-ILD group was higher than that of uncomplicated RA group.5.Level of Fg [(5.59 ±3.04)g/L vs.(5.14 ±2.50) g/L)],RF [(704.90 ±1 326.64)U/ml vs.(389.42 ±669.15)U/ml],CRP [(56.70 ±56.07)mg/L vs. (45.71 ±52.64)mg/L]and IgA [(3.62 ±1.74)g/L vs.(3.21 ±1.50)g/L]were significantly higher in the RA-ILD group that those of the uncomplicated RA group.And the serum albumin level [(42.35 ±5.17) g/L vs.(43.89 ±6.03)g/L]was lower than uncomplicated RA group (P <0.05).Conclusion RA patients with elder age or long disease duration or obvious symptoms of joints are prone to complicate with ILD.And sustained abnormality of Fg、CRP、Bun、C-cys、A1b、WBC、NE、α1-globulin and α2-globulin may be related to the development of ILD in RA patients,which may be the predictive factors for the development of ILD in RA patients.In addition,pulmonary high-resolution CT and pulmonary diffuse function are both important tests for the early diagnosis of ILD in RA patients.
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