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目的了解类风湿关节炎肺间质病变(RA-ILD)的发生情况、特征及相关因素分析,以便早期发现RA的肺部病变。方法类风湿关节炎(RA)患者85例,免疫比浊法检测类风湿因子(RF)、C反应蛋白(CRP)、免疫球蛋白及补体;间接免疫荧光法和免疫印迹法检测抗核抗体(ANA)及亚类;放射免疫法检测血清层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ·C)、透明质酸(HA)、Ⅲ型前胶原(PcⅢ)的水平。血气分析测定动脉血氧分压(PaO2)、动脉二氧化碳分压(PaCO)和肺泡—动脉血氧分压差(PA-aO2)。肺功能仪测定潮气2容积(VT)、最大肺活量(VCmax)、用力肺活量(FVC)、1s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片、双手像和肺高分辨率CT(HRCT)扫描。结果①本组RA患者出现ILD的占32.9%,易出现于男性、年龄大、病程长、病情重、RF滴度高的患者。②RA-ILD患者血清LN、PcⅢ、Ⅳ·C、HA水平明显升高,尤其LN和PcⅢ较无ILD组和对照组均高。③肺功能检测异常主要为弥散功能降低和限制性通气障碍。④肺HRCT在发现RA-ILD病变时优于普通胸片。根据临床表现、肺功能、胸片和⑤HRCT结果,可将患者分为临床前期型、急性肺泡炎型、慢性肺间质病变型三个亚型。结论RA-ILD的发生与疾病活动性和严重性
Objective To investigate the occurrence, characteristics and related factors of rheumatoid arthritis (RA-ILD) in order to detect the pulmonary lesions of RA early. Methods Eighty-five patients with rheumatoid arthritis (RA) were enrolled in this study. Rheumatoid factor (RF), C-reactive protein (CRP), immunoglobulin and complement were detected by immunoturbidimetric assay. ANA) and subclass were detected by radioimmunoassay. Serum levels of laminin (LN), type Ⅳ collagen (Ⅳ · C), hyaluronic acid (HA) and type Ⅲ procollagen (PcⅢ) were detected by radioimmunoassay. Blood gas analysis was performed to determine PaO 2, PaCO, and PA-aO. Pulmonary function tests were used to measure the changes of VT, VCmax, FEV1, MMFF, MVV and diffuse carbon monoxide Function (DLCO). Radiological examinations include a positive chest radiograph, both hands and pulmonary high resolution CT (HRCT) scans. Results ① The incidence of ILD in RA patients was 32.9%. It was easy to occur in patients with male, older age, longer duration, severe illness and high RF titer. ② Serum levels of LN, PcⅢ, Ⅳ · C and HA were significantly increased in patients with RA-ILD, especially LN and PcⅢ were higher than those without ILD and control group. ③ abnormal lung function tests mainly for the reduction of diffuse function and restrictive ventilation disorders. ④ lung HRCT is superior to the common chest when RA-ILD lesions are found. According to clinical manifestations, lung function, chest radiography and ⑤ HRT results, patients can be divided into preclinical, acute alveolar type, chronic interstitial lung disease three subtypes. Conclusions RA-ILD occurrence and disease activity and severity