Zhang Yongfeng, Li Hongbin, Wu Nawei, Dong Xin, Zheng Yi
Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, Beijing, 100020, China.
Department of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
Clin Rheumatol. 2017 Apr;36(4):817-823. doi: 10.1007/s10067-017-3561-5. Epub 2017 Feb 12.
This study aims to explore the clinical characteristics and risk factors of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). This is a retrospective study of 550 patients with RA. All patients underwent chest high-resolution computed tomography (HRCT) scanning. (1) Two hundred thirty-seven out of five hundred fifty (43.1%) patients with RA were diagnose with ILD. 13.5% ILD occurred before RA onset, 69.6% ILD occurred within 10 years of RA onset, and 16.9% ILD occurred more than 10 years after RA onset. (2) The most common chest CT characteristics of RA-ILD included reticular patterns (57.8%), pleural thickening (57%), ground-glass attenuation (53.2%), followed by interlobular septum thickening, nodules, emphysematous bullae, honeycombing, and bronchiectasis. The proportion of the UIP pattern and NSIP on HRCT was 18.6% and 57.8%. (3) RA-ILD was often associated with other lung lesions, including pleural disease, bronchiectasis, and pulmonary hypertension. (4) the comparisons between RA with ILD and RA without ILD showed that male, smoking, age, disease duration, number of swelling joints, globulin levels, erythrocyte sedimentation rate, C-reactive protein levels, lactate dehydrogenase, the positive rate of rheumatoid factor (RF) and the absolute value of RF, forced vital capacity, forced expiratory volume in 1 s, and carbon monoxide diffusion rate, were statistically different (P < 0.05). Logistic regression analysis showed that age, smoking, elevated lactate dehydrogenase, and RF positive were closely correlated to RA-ILD. RA-ILD occurs more often within 10 years of RA onset and coexists with other lung lesions. The elevated lactate dehydrogenase, RF positive, smoking, and advanced age are closely correlated with RA-ILD.
本研究旨在探讨类风湿关节炎（RA）相关间质性肺疾病（ILD）的临床特征及危险因素。这是一项对550例RA患者的回顾性研究。所有患者均接受了胸部高分辨率计算机断层扫描（HRCT）。（1）550例RA患者中有237例（43.1%）被诊断为ILD。13.5%的ILD在RA发病前出现，69.6%的ILD在RA发病后10年内出现，16.9%的ILD在RA发病10年后出现。（2）RA-ILD最常见的胸部CT特征包括网状影（57.8%）、胸膜增厚（57%）、磨玻璃影（53.2%），其次为小叶间隔增厚、结节、肺气肿大疱、蜂窝肺和支气管扩张。HRCT上UIP型和NSIP型的比例分别为18.6%和57.8%。（3）RA-ILD常与其他肺部病变相关，包括胸膜疾病、支气管扩张和肺动脉高压。（4）有ILD的RA患者与无ILD的RA患者比较显示，男性、吸烟、年龄、病程、肿胀关节数、球蛋白水平、红细胞沉降率、C反应蛋白水平、乳酸脱氢酶、类风湿因子（RF）阳性率及RF绝对值、用力肺活量、第1秒用力呼气量和一氧化碳弥散率，差异有统计学意义（P<0.05）。Logistic回归分析显示，年龄、吸烟、乳酸脱氢酶升高和RF阳性与RA-ILD密切相关。RA-ILD多在RA发病后10年内出现，并与其他肺部病变共存。乳酸脱氢酶升高、RF阳性、吸烟和高龄与RA-ILD密切相关。
