Yousem S A, Colby T V, Carrington C B
Am Rev Respir Dis. 1985 May;131(5):770-7. doi: 10.1164/arrd.1985.131.5.770.
Forty open lung biopsies from patients with rheumatoid arthritis and possible "rheumatoid lung disease" were reviewed in an attempt to correlate histology with radiologic, physiologic, and prognostic variables. A wide variety of histopathologic features was seen, and primary and secondary patterns of injury were recognized. Five different groups based on histologic patterns were identified: pulmonary rheumatoid nodules, usual interstitial pneumonia (UIP), bronchiolitis obliterans with patchy organizing pneumonia (BOOP), lymphoid hyperplasia, and cellular interstitial infiltrates. The finding of rheumatoid nodules as the primary pattern imparted a uniformly good prognosis, whereas the pattern of UIP indicated a poor one. Patients with BOOP had a more favorable prognosis than did patients with UIP, as did patients with lymphoid hyperplasia and/or nonspecific cellular interstitial infiltrates. Consistent correlations between pulmonary function testing and roentgenographic and histologic findings were not found. The term "rheumatoid lung disease" is of no use as a histologic diagnosis because it encompasses a broad spectrum of morphologic changes that carry significantly different prognoses.
对40例患有类风湿性关节炎且可能患有“类风湿性肺病”的患者进行了开放性肺活检，旨在将组织学与放射学、生理学及预后变量进行关联分析。观察到了多种组织病理学特征，并识别出了原发性和继发性损伤模式。基于组织学模式确定了五个不同的组：肺类风湿结节、寻常型间质性肺炎（UIP）、闭塞性细支气管炎伴斑片状机化性肺炎（BOOP）、淋巴样增生以及细胞性间质浸润。以类风湿结节作为主要模式的患者预后普遍良好，而UIP模式则提示预后不良。与UIP患者相比，BOOP患者、淋巴样增生和/或非特异性细胞性间质浸润患者的预后更为良好。未发现肺功能测试结果与放射学及组织学表现之间存在一致的相关性。“类风湿性肺病”这一术语作为组织学诊断并无用处，因为它涵盖了一系列预后差异显著的形态学改变。
