结缔组织疾病相关性间质性肺疾病219例临床分析

摘要

目的 研究结缔组织疾病相关性间质性肺疾病(connective tissue disease related interstitial lung disease,CTD-ILD)患者的临床资料,提高对CTD-ILD的认识及诊疗水平.方法 回顾性分析2012年1月至2016年1月我院收治的CTD-ILD患者的临床表现、实验室检查、肺功能、胸部CT/HRCT、治疗等资料.结果 1644例CTD患者中607例因有呼吸系统症状行胸部CT/HRCT检查,607例患者中根据诊断标准诊断为CTD-ILD 219例,男64例,女155例.SSc-ILD发生率最高,占总例数(11/25,44%),占有呼吸道症状且行胸部CT/HRCT患者占73.3%(11/15).呼吸道症状以咳嗽、气促为主.影像学表现以NSIP(152/219,69.4%)最常见,多见于MCTD、PM/DM,其次为UIP(57/219,26%),多见于UCTD、RA,LIP 2例分别见于SS和RA.肺功能主要表现为弥散功能障碍和限制性通气功能障碍.所有患者血沉均升高,其中RA-ILD最明显,为(62.26±34.45)mm/h.治疗均采用激素,大部分患者加用免疫抑制剂,118例(53.9%)临床好转.结论 CTD常累及肺,对CTD患者应行胸部HRCT和肺功能评估肺部情况.大多数患者影像学表现为NSIP,早期合理的激素加免疫抑制剂的治疗对逆转病情和改善预后有积极的作用.%Objective To study the clinical data of patients with connective tissue disease related interstitial lung disease ( connective tissue related interstitial lung disease,CTD-ILD) ,and to improve the level of diagnosis and treatment of CTD-ILD.Method The clinical manifestations, laboratory examination, pulmonary function, chest CT/HRCT and treatment of CTD-ILD pa-tients admitted to the First Affiliated Hospital of Chongqing Medical University from January 2012 to January 2016 were retrospectively analyzed. Results In 1644 patients with CTD,CT/HRCT examination was performed in 607 patients with respiratory symptoms. Of the 607 patients,219 were diagnosed as CTD-ILD according to the diagnostic criteria,including 64 cases of male and 155 cases of fe-male. The incidence of SSc-ILD was the highest,accounting for the total number of cases(11/25,44%),which had respiratory symp-toms and chest CT/HRCT(11/15,73. 3%). Cough and shortness of breath were the main respiratorysymptoms. NSIP was the most common imaging manifestations(152/219,69. 4%),more common in MCTD,PM/DM. Followed by UIP(57/219,26%),more com-mon in UCTD,RA. 2 cases of LIP were respectively found in SS and RA. Lung function was mainly manifested as diffuse dysfunction and restrictive ventilation dysfunction. The erythrocyte sedimentationof all patients was increased,and RA-ILD was the most obvious, which was(62. 26 + 34. 45)mm/h. All patients were treated with hormone,and most patients were treated with immunosuppressive a-gents,118 cases(53. 9%)were improved. Conclusion CTD is often involved in the lung,and CTD patients should be evaluated by chest HRCT and pulmonary function. Most of the patients are NSIP,and the early treatment with hormone and immunosuppressive a-gents has a positive effect on reversing the disease and improving the prognosis.