【摘要】 目的:分析类风湿关节炎(rheumatoid arthritis,RA)合并肺间质纤维化(interstitial pulmonary fibrosis,IPF)患者的临床特点。方法:回顾性总结2006年在北京大学人民医院风湿免疫科住院的198例RA患者,分析其中RA-IPF患者的临床及实验室指标,并比较合并和不合并IPF的RA患者年龄、病程、临床表现、实验室指标、吸烟及用药史等,系统分析RA-IPF患者的临床特点。结果:(1)198例RA患者中30例合并IPF,占15.2%(30/198)。所有RA-IPF患者均存在高分辨率CT(high resolution computer tomography,HRCT)改变,其中63.3%(19/30)患者胸部X线提示IPF,46.7%(14/30)患者有呼吸道症状,50.0%(15/30)患者存在肺底Velcro啰音。30例RA-IPF患者中均无杵状指,仅1例伴低氧血症。多数患者IPF发生于关节症状之后。(2)合并IPF的RA患者组年龄明显高于不合并IPF组[(65.50±9.71)vs(55.22±12.98)岁,P<0.01];抗角蛋白抗体(anti-keratin antibodies,AKA)阳性率明显增高(61.5%vs35.9%,P=0.014);RA-IPF组抗环瓜氨酸肽(cyclic citrullinated peptide,CCP)抗体水平明显高于不合并IPF的RA患者[(4.38±2.08)vs(3.20±2.12),P=0.01]。两组患者病程、吸烟史和用药史、IgM型类风湿因子、IgG型类风湿因子、抗核抗体、抗SSA抗体、免疫球蛋白和补体水平等比较差异无统计学意义。结论:RA-IPF患者多数临床表现轻微,老年患者多见,AKA和抗CCP抗体可能是与RA-IPF密切相关的重要抗体。更多还原

【Abstract】 Objective:To analyze the clinical characteristics of interstitial pulmonary fibrosis(IPF) in patients with Rheumatoid arthritis(RA).Methods: We retrospectively analyzed 198 RA patients with or without IPF.Characteristics of RA-IPF in clinical and lab data were analyzed.Age,duration of disease,clinical and laboratory parameters,history of smoking and medicine were compared between the patients with and without IPF.Results:(1) Among the 198 RA patients,15.2%(30/198) were found with IPF.100% RA-IPF patients had HRCT findings.However,63.3%(19/30) had positive findings in chest X-ray,and only 46.7%(14/30) had the complaints of cough and short breath.Velcro rales were found in 50.0%(15/30) patients with IPF and no acropachy occurred.Only one patient suffered from hypoxemia.IPF presented after the joint symptoms in most patients.(2) RA-IPF patients were older than those without IPF [(65.50 ± 9.71) vs(55.22 ± 12.98) years,P<0.01];Higher positivity of anti-keratin antibodies(AKA) were found in RA-IPF compared to patients without IPF(61.5% vs 35.9%,P=0.014).Furthermore,the levels of anti-cyclic citrullinated peptide(CCP) antibody were significantly higher in RA-IPF [(4.38 ± 2.08) vs(3.20 ± 2.12),P=0.01].No differentiation of duration of disease,history of smoking and medicine,IgM rheumatoid factor,IgG rheumatoid factor,anti-nuclear antibody,anti-SSA antibody and levels of immunoglobins and complements were found between the two groups of RA patients with and without IPF.Conclusion: The clinical symptoms of IPF in RA patients are mild and more common in older patients.AKA and anti-CCP antibody might be important antibodies associated with RA-IPF.更多还原