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类风湿关节炎的呼吸症状:与高分辨率 CT 和肺功能检测发现的肺部异常的关系。

Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing.

机构信息

Rheumatology and Rehabilitation Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

出版信息

Rheumatol Int. 2012 Jul;32(7):1985-95. doi: 10.1007/s00296-011-1905-z. Epub 2011 Apr 3.

Abstract

Pulmonary disease is the most frequent and among the most severe extra-articular manifestation of rheumatoid arthritis (RA). However, this issue has not been sufficiently studied in Egyptian patients. The objectives of the present study are to investigate the prevalence and types of pulmonary involvement using high-resolution computed tomography scan (HRCT) and pulmonary function tests (PFT) and evaluate the association between respiratory symptoms and RA-lung disease in a group of Egyptian RA patients. Thirty-six RA patients were recruited; 34 females (94.4%) and 2 males (5.6%) with median age of 48.5 years, and none of them was smoker. Detailed medical and drug histories were obtained. PFT, plain X-ray of the chest, and HRCT were performed to all subjects involved. Nearly 64% of RA patients demonstrated abnormalities in PFT and 47% in HRCT. Mixed restrictive and obstructive pattern was the commonest. Nearly two-thirds of our patients reported one or more pulmonary symptom whether dyspnea, cough, wheezing, or phlegm. Dyspnea was the most frequent symptom. Respiratory symptoms were statistically more common in patients with lung disease. The advanced age, high radiological score, and severity of rheumatoid disease were found to be predictive of lung involvement. Among respiratory symptoms, dyspnea and cough were associated with any pulmonary abnormalities. When specific pulmonary abnormalities were considered, only dyspnea was identified as predictor for restriction. For obstructive abnormality, both cough and wheezing provided valid prediction. We conclude that pulmonary involvement is a common manifestation in Egyptian RA patients, and the pattern of involvement is generally consistent with other studies that were performed worldwide. Specific respiratory symptoms could be used as practical, easy, and cost-effective method, especially in older and with more severe RA patients, to discriminate patients in need of subsequent PFT and HRCT imaging.

摘要

肺部疾病是类风湿关节炎(RA)最常见且最严重的关节外表现之一。然而,在埃及患者中,这一问题尚未得到充分研究。本研究的目的是通过高分辨率计算机断层扫描(HRCT)和肺功能检查(PFT)来调查肺部受累的发生率和类型,并评估一组埃及 RA 患者的呼吸症状与 RA-肺部疾病之间的关系。

研究纳入了 36 名 RA 患者,其中 34 名女性(94.4%)和 2 名男性(5.6%),中位年龄为 48.5 岁,且均无吸烟者。详细的医疗和药物史均被获取。所有受试者均进行了 PFT、胸部平片和 HRCT 检查。

约 64%的 RA 患者的 PFT 异常,47%的 HRCT 异常。最常见的是混合限制性和阻塞性模式。我们近三分之二的患者报告了一种或多种肺部症状,包括呼吸困难、咳嗽、喘息或咳痰。呼吸困难是最常见的症状。有肺部疾病的患者呼吸症状更为常见。高龄、高影像学评分和严重的类风湿疾病与肺部受累相关。在呼吸症状中,呼吸困难和咳嗽与任何肺部异常相关。当考虑特定的肺部异常时,只有呼吸困难被确定为限制的预测因素。对于阻塞性异常,咳嗽和喘息均可提供有效的预测。

综上所述,肺部受累是埃及 RA 患者的常见表现,受累模式通常与在全球范围内进行的其他研究一致。特定的呼吸症状可以作为一种实用、简单且具有成本效益的方法,尤其是在年龄较大且类风湿疾病更为严重的患者中,以区分需要进一步进行 PFT 和 HRCT 成像的患者。

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