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目的探讨原发性干燥综合征合并间质性肺病(pSS!ILD)的发生情况、特征及早期诊断方法。方法对96例原发性干燥综合征患者(pSS),采用速率反射比浊法检测类风湿因子(RF)、C!反应蛋白(CRP)、血蛋白电泳、C3、C4;间接免疫荧光法和免疫印迹法检测抗核抗体(ANA)及其亚类。血气分析测定动脉血pH值、动脉血氧分压(PO2)、动脉血二氧化碳分压(PCO2)。肺功能仪测定潮气容积(VT)、最大肺活量(VCmax)、用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、最大呼气中段流量(MMFF)、最大通气量(MVV)和一氧化碳弥散功能(DLCO)。放射学检查包括胸部正侧位X线片和肺高分辨CT(HRCT)扫描。结果本组pSS患者ILD的发生率为21.9%,易出现于抗SSA抗体阳性、RF高滴度、高γ球蛋白血症及临床活动期的患者;肺功能检测异常主要为弥散功能降低和限制性通气障碍;肺HRCT在发现pSS!ILD时优于普通X线胸片。结论pSS!ILD的发生与原发病的活动明显相关,肺弥散功能、HRCT对诊断pSS!ILD及判断预后具有重要价值;早期诊断与治疗的患者预后良好。
Objective To investigate the occurrence, characteristics and early diagnosis of primary Sjogren’s syndrome complicated with interstitial lung disease (pSS! ILD). Methods Ninety - six patients with primary Sjogren ’s Syndrome (SS) were studied with rheumatoid factor (RF), C reactive protein (CRP), hemoglobin electrophoresis, C3 and C4 by indirect reflectance nephelometry and indirect immunofluorescence Anti-nuclear antibody (ANA) and its subclasses were detected by Western blotting. Blood gas analysis was used to measure arterial blood pH, arterial oxygen partial pressure (PO2) and arterial carbon dioxide partial pressure (PCO2). The pulmonary function test was used to measure the values of VT, VCmax, FVC, FEV1, MMFF, MVV and carbon monoxide Diffuse function (DLCO). Radiological examinations include an anterior chest radiograph and a lung high resolution CT (HRCT) scan. Results The incidence of ILD was 21.9% in patients with pSS, which was easily found in patients with positive anti-SSA antibody, high RF titer, high-gamma globulin and clinical active stage. The abnormal pulmonary function tests mainly included the decrease and limitation of diffuse function Ventilation Disorders; Lung HRCT is superior to plain X-ray in detecting pSS! ILD. Conclusions The incidence of pSS! ILD is significantly correlated with the activity of the primary disease. Pulmonary diffuse function and HRCT are of great value in the diagnosis of pSS! ILD and prognosis. Early diagnosis and treatment of patients with good prognosis.