矽肺患者系统性自身免疫性风湿病的患病率及临床影响

Prevalence and Clinical Impact of Systemic Autoimmune Rheumatic Disease in Patients with Silicosis.

作者信息

Blanco Pérez José Jesús, Arnalich Montiel Victoria, Salgado-Barreira Ángel, Alvarez Moure María Angel, Caldera Díaz Adriana Carolina, Melero Gonzalez Rafael, Pallarés Sanmartín Abel, Fernandez Villar Alberto, González Barcala Francisco Javier

机构信息

Servicio de Neumoloxía. Hospital Álvaro Cunqueiro. Complexo Hospitalario Universitario de Vigo, España; IRIDIS Group (Investigation in Rheumatology and Immuno-Mediated Diseases) del Instituto de Investigación Sanitaria Galicia Sur, Vigo, España.

Servicio de Neumoloxía. Hospital Álvaro Cunqueiro. Complexo Hospitalario Universitario de Vigo, España.

出版信息

Arch Bronconeumol (Engl Ed). 2020 May 31. doi: 10.1016/j.arbres.2020.04.012.

DOI:10.1016/j.arbres.2020.04.012

PMID:32493645

Abstract

BACKGROUND

Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis.

METHOD

We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed.

RESULTS

Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0 vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030).

CONCLUSIONS

The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.

摘要

背景

矽肺与发生系统性自身免疫性风湿性疾病（SARD）的风险增加相关。这种关联的预后意义尚未得到充分描述。本研究的目的是确定一组接触二氧化硅的患者中SARD和自身免疫标志物的患病率，并评估它们对预后的影响。

方法

我们对2009年至2017年12月期间在我们肺病科专门的矽肺诊所就诊的所有患者进行了一项前瞻性观察研究。由风湿病学家根据西班牙风湿病学会标准确诊。分析了自身免疫标志物、肺功能测试、放射学进展、急诊室和初级保健中心就诊情况、因呼吸原因住院情况以及死亡率。

结果

总体而言，研究了489例矽肺病例和95例接触病例。共有54例（11.0%）矽肺患者患有SARD：12例（2.4%）类风湿性关节炎，10例（2.0%）系统性红斑狼疮，10例（2.0%）系统性硬化症，3例（0.6%）干燥综合征，2例（0.4%）抗中性粒细胞胞浆抗体相关血管炎（ANCA+），6例（1.2%）银屑病关节炎，3例（0.6%）强直性脊柱炎，8例（1.6%）其他无特殊特征的自身免疫性疾病。患有SARD的患者更频繁地前往急诊室（63.0%对42.5%；p=0.004），并且进展更快（22.2%对11.7%；p=0.030）。