Yao Xuan, Abd Hamid Megat, Sundaralingam Anand, Evans Alice, Karthikappallil Roshan, Dong Tao, Rahman Najib M, Kanellakis Nikolaos I
Chinese Academy of Medical Sciences Oxford Institute, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.
MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
Breathe (Sheff). 2020 Dec;16(4):200203. doi: 10.1183/20734735.0203-2020.
Systemic inflammatory diseases are a heterogeneous family of autoimmune chronic inflammatory disorders that affect multiple systems within the human body. Connective tissue disease (CTD) is a large group within this family characterised by immune-mediated inflammation of the connective tissue. This group of disorders are often associated with pleural manifestations. CTD-induced pleuritis exhibits a wide variety of symptoms and signs including exudative pleural effusions and chest pain. Accurate estimation of prevalence for CTD-related pleuritis is challenging as small effusions are asymptomatic and remain undetected. Rheumatoid arthritis and systemic lupus erythematosus are frequent CTDs and present with pleural pathology in approximately 5-20% and 17-60% of cases, respectively. By contrast, pleural involvement in systemic sclerosis, eosinophilia-myalgia syndrome, mixed connective tissue disease, ankylosing spondylitis, polymyositis and dermatomyositis syndrome is rare. Clinical management depends on the severity of symptoms; however, most effusions resolve spontaneously. In this review we discuss the pathophysiological mechanisms and the clinical considerations of CTD-induced pleuritis.
全身性炎症性疾病是一类异质性的自身免疫性慢性炎症性疾病，会影响人体的多个系统。结缔组织病（CTD）是该类疾病中的一个大类，其特征是结缔组织的免疫介导性炎症。这组疾病常伴有胸膜表现。CTD 诱发的胸膜炎表现出各种各样的症状和体征，包括渗出性胸腔积液和胸痛。由于少量积液无症状且未被发现，准确估计 CTD 相关胸膜炎的患病率具有挑战性。类风湿性关节炎和系统性红斑狼疮是常见的 CTD，分别约有 5-20%和 17-60%的病例出现胸膜病变。相比之下，系统性硬化症、嗜酸性粒细胞肌痛综合征、混合性结缔组织病、强直性脊柱炎、多发性肌炎和皮肌炎综合征累及胸膜的情况较为罕见。临床管理取决于症状的严重程度；然而，大多数积液会自行消退。在本综述中，我们讨论了 CTD 诱发胸膜炎的病理生理机制和临床注意事项。
