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类风湿性关节炎之肺部损害最常表现为胸膜炎、弥漫性纤维化性肺泡炎,蜂窝肺或有类风湿结节。发生肺动脉高压者少见,且往往继发于蜂窝肺。然偶仅有肺动脉高压伴小肺动脉改变,而无原发性肺实质损害。作者报告1例女性,24岁,类风湿性关节炎8年死亡。死前4个月发现肺动脉高压证据,包括紫绀、肺动脉瓣第二音分裂,X线证实肺动脉增宽,心电图示右心室劳损伴右束支传导阻滞。尸检发现右心室肥厚,镜检见肌性肺动脉中层肥厚和内膜纤维化,有些肺动脉中层纤维素样坏死和急性动脉炎,符合6级肺血管高压性病变。作者认为,此例肺动脉纤维素样坏死为严重肺动脉高压病变之一,而非原发性类风湿性
Lung damage in rheumatoid arthritis is most often manifested as pleurisy, diffuse fibrotic alveolitis, cellular lung or rheumatoid nodules. Occurrence of pulmonary hypertension are rare, and often secondary to the cellular lung. However, even only pulmonary hypertension with small pulmonary artery changes, without primary pulmonary parenchymal damage. The authors report 1 female, 24 years of age, and 8 years of rheumatoid arthritis. Evidence of pulmonary hypertension was found 4 months prior to death, including cyanosis, pulmonary second pulmonary fissure, X-ray evidence of pulmonary artery widening, ECG right ventricular strain with right bundle branch block. Autopsy revealed right ventricular hypertrophy, microscopic examination of muscular pulmonary middle layer of hypertrophy and endometrial fibrosis, some pulmonary middle layer of cellulose-like necrosis and acute arteritis, in line with grade 6 pulmonary hypertension. The authors believe that this case of pulmonary artery fibrosis-like necrosis is one of the serious pulmonary hypertension, rather than primary rheumatoid