类风湿关节炎相关的间质性肺疾病：组织病理学和影像学模式的相关性。
Rheumatoid arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern.
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, CA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, CA.
出版信息
Chest. 2009 Nov;136(5):1397-1405. doi: 10.1378/chest.09-0444.
Interstitial lung disease (ILD) is a frequent extraarticular manifestation of rheumatoid arthritis (RA). While the nonspecific interstitial pneumonia pattern predominates in most forms of connective tissue-associated ILD, studies in patients with RA-associated ILD (RA-ILD) suggest that the usual interstitial pneumonia (UIP) pattern is more common in this patient population. High-resolution CT (HRCT) scans appear accurate in identifying UIP pattern in many patients with RA-ILD. Although the data are limited, UIP pattern appears to predict worse survival in RA-ILD patients. Larger, prospective, multicenter studies are needed to confirm this finding. We propose that the evaluation of patients with RA-ILD should focus on identifying those with UIP pattern on HRCT scans, as these patients are likely to carry a worse prognosis. In patients in whom the underlying pattern cannot be determined by HRCT scanning, surgical lung biopsy should be considered.
间质性肺病（ILD）是类风湿关节炎（RA）常见的关节外表现。虽然大多数结缔组织相关ILD 中以非特异性间质性肺炎模式为主，但 RA 相关 ILD（RA-ILD）患者的研究表明，寻常型间质性肺炎（UIP）模式在该患者人群中更为常见。高分辨率 CT（HRCT）扫描似乎可准确识别许多 RA-ILD 患者的 UIP 模式。尽管数据有限，但 UIP 模式似乎预示着 RA-ILD 患者的生存率更差。需要更大规模、前瞻性、多中心研究来证实这一发现。我们建议，对 RA-ILD 患者的评估应侧重于识别 HRCT 扫描上存在 UIP 模式的患者，因为这些患者预后可能更差。对于 HRCT 扫描无法确定潜在模式的患者，应考虑进行外科肺活检。
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