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结缔组织病相关间质性肺病患者的临床特征:一项回顾性分析。

Clinical characteristics of patients with connective tissue disease-related interstitial lung disease: a retrospective analysis.

作者信息

Colak Seda, Tekgoz Emre, Gunes Ezgi Cimen, Ocal Nesrin, Dogan Deniz, Tasci Canturk, Cinar Muhammet, Yilmaz Sedat

机构信息

Rheumatology Department, Gulhane Training and Research Hospital, Ankara, Turkey.

Pulmonology Department, Gulhane Training and Research Hospital, Ankara, Turkey.

出版信息

Clin Rheumatol. 2024 May;43(5):1693-1701. doi: 10.1007/s10067-024-06926-3. Epub 2024 Mar 9.

Abstract

INTRODUCTION

Interstitial lung disease is one of the most critical manifestations of connective tissue diseases that may cause morbidity and mortality. This study aimed to evaluate the clinical and demographic characteristics and treatment of the patients with connective tissue disease-related interstitial lung disease.

METHOD

This retrospective observational study included patients from the Gulhane Rheumatology Interstitial Lung Disease cohort between October 2016 and June 2023. The patients were assessed retrospectively.

RESULTS

A total of 173 patients were included in the study with a mean age of 63.4 ± 11.9 years. The frequencies of CTD were 34.1% Sjogren's syndrome, 30.1% rheumatoid arthritis, 25.4% systemic sclerosis, 5.8% undifferentiated connective tissue disease, 2.9% idiopathic inflammatory myositis, 1.2% mixt connective tissue disease, and 0.6% systemic lupus erythematosus in decreasing frequencies. Nonspecific interstitial pneumonia, which was the most common interstitial lung disease pattern in 103 (59.5%) patients, was most frequent among patients with SS and SSc (p < 0.001 vs. p < 0.001). Usual interstitial pneumonia was most frequent among patients with RA (p < 0.001). All patients received immunosuppressive treatment, most commonly azathioprine. 57.2% were using immunosuppressives for ILD. Six patients had mortality, and infections were the leading cause.

CONCLUSIONS

As a critical manifestation of connective tissue diseases, immunosuppressive treatment is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections. Key Points • Interstitial lung disease is a noteworthy manifestation of connective tissue diseases. • The clinical findings, treatment requirements, and progression vary according to the severity of the disease. • Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.

摘要

引言

间质性肺疾病是结缔组织病最关键的表现之一,可能导致发病和死亡。本研究旨在评估结缔组织病相关间质性肺疾病患者的临床和人口统计学特征及治疗情况。

方法

这项回顾性观察研究纳入了2016年10月至2023年6月期间古尔汗风湿病间质性肺疾病队列中的患者。对患者进行回顾性评估。

结果

本研究共纳入173例患者,平均年龄为63.4±11.9岁。结缔组织病的发生率从高到低依次为干燥综合征34.1%、类风湿关节炎30.1%、系统性硬化症25.4%、未分化结缔组织病5.8%、特发性炎性肌病2.9%、混合性结缔组织病1.2%、系统性红斑狼疮0.6%。非特异性间质性肺炎是103例(59.5%)患者中最常见的间质性肺疾病类型,在干燥综合征和系统性硬化症患者中最为常见(分别与其他疾病相比,p<0.001)。普通型间质性肺炎在类风湿关节炎患者中最为常见(p<0.001)。所有患者均接受免疫抑制治疗,最常用的是硫唑嘌呤。57.2%的患者因间质性肺疾病使用免疫抑制剂。6例患者死亡,感染是主要原因。

结论

作为结缔组织病的关键表现,免疫抑制治疗在间质性肺疾病的管理中不可或缺,尤其是对于那些进展风险增加的疾病。治疗方法应以患者为基础进行评估。接受免疫抑制治疗的患者应谨慎随访有无感染。要点:• 间质性肺疾病是结缔组织病的一个值得关注的表现。• 临床发现、治疗需求和疾病进展因疾病严重程度而异。• 对于症状恶化、肺功能检查受损和有影像学表现的患者,免疫抑制治疗可能至关重要。

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