CAJ | 학술논문

目的观察治疗前后类风湿关节炎(RA)继发间质性肺疾病( ILD)患者胸部高分辨率CT( HRCT)和生活质量的变化及与HRCT相关的主要因素.方法 26例初治RA-ILD患者,观察治疗前、治疗12周及24周临床特征、HRCT、生活质量的变化,治疗前后指标变化采用重复测量资料的方差分析,用多元回归的方法分析HRCT与其他指标的相关性.结果 26例患者中男性12例(46％).随访24周,11例出现肺部感染,发生率42％.激素联合环磷酰胺治疗24周,HRCT评分(8±6)较治疗前(12±5)明显好转,治疗12周HRCT显示12例有吸收,治疗24周16例有吸收,6例无明显变化,4例进展.治疗后患者生活质量圣乔治呼吸问卷(SGRQ)中影响分、症状分、活动分、总均分明显下降(F=3.783,6.362,4.217,4.426;均P＜0.05),健康状况调查问卷(SF-36)中身体和精神健康各项指标均较治疗前明显提高(P＜0.01).HRCT的相关因素:治疗前SGRQ中影响分(P=0.000)、症状分(P=0.001)、SF-36中精力(P=0.012)、球蛋白(P=0.027)；治疗24周SGRQ中症状分(P=0.001)、病程(P=0.002)、英国医学研究会呼吸困难量表(MRC)气促分级(P=0.011)、SF-36中精力(P=0.036).结论男性RA易继发ILD,RA-ILD易出现肺部感染,早期治疗后大部分患者胸部HRCT有吸收,生活质量明显提高.呼吸道症状、气促程度、球蛋白、病程及患者的精力与HRCT明显相关.
목적 관찰치료전후류풍습관절염(RA)계발간질성폐질병( ILD)환자흉부고분변솔CT( HRCT)화생활질량적변화급여HRCT상관적주요인소.방법 26례초치RA-ILD환자,관찰치료전、치료12주급24주림상특정、HRCT、생활질량적변화,치료전후지표변화채용중복측량자료적방차분석,용다원회귀적방법분석HRCT여기타지표적상관성.결과 26례환자중남성12례(46％).수방24주,11례출현폐부감염,발생솔42％.격소연합배린선알치료24주,HRCT평분(8±6)교치료전(12±5)명현호전,치료12주HRCT현시12례유흡수,치료24주16례유흡수,6례무명현변화,4례진전.치료후환자생활질량골교치호흡문권(SGRQ)중영향분、증상분、활동분、총균분명현하강(F=3.783,6.362,4.217,4.426;균P＜0.05),건강상황조사문권(SF-36)중신체화정신건강각항지표균교치료전명현제고(P＜0.01).HRCT적상관인소:치료전SGRQ중영향분(P=0.000)、증상분(P=0.001)、SF-36중정력(P=0.012)、구단백(P=0.027)；치료24주SGRQ중증상분(P=0.001)、병정(P=0.002)、영국의학연구회호흡곤난량표(MRC)기촉분급(P=0.011)、SF-36중정력(P=0.036).결론 남성RA역계발ILD,RA-ILD역출현폐부감염,조기치료후대부분환자흉부HRCT유흡수,생활질량명현제고.호흡도증상、기촉정도、구단백、병정급환자적정력여HRCT명현상관.
Objective To investigate the changes of high resolution computerized tomography (HRCT) of chest and quality of life and the main correlated factors of HRCT for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA).Methods Twenty-six initial treatment patients with RA-ILD were enrolled.The following parameters were noted at baseline,12 and 24 weeks for each patient:clinical features,HRCT,quality of life.ANOVA was used for repeated measurement data and stepwise multiple regression analysis were used to analyze the relativity between HRCT and other parameters.Results Twentysix patients were included.Twelve male(46％) patients were followed up for 24 weeks and pulmonary infection occurred in 11 patients,so the frequency rate was 42％.After being treated with prednisone and cyclophosphamide for 24 weeks,the HRCT scores were lower than before [(8+6) vs(12±5),respectively] and 16 patients' condition were improved,6 were in stable and 4 had deteriorated disease.For quality of life,the impact scores,symptom scores,activity scores,and total scores of St.George's respiratory questionnaire (SGRQ) were significantly decreased (F=3.783,6.362,4.217,4.426,P＜0.05) and all domains of the short form-36 health survey questionnaire(SF-36) had significant improvement after treatment.Stepwise multiple regression analysis showed that the impact scores (P=0.000) and symptom scores (P=0.001) of SGRQ,vitality (P=0.012) of questionnaire,globulin (P=0.027) in prior treatment and symptom scores (P--0.001 ) of SGRQ,course of disease (P=0.002),MRC score (P=0.011),vitality (P=0.036) of SF-36 questionnaire in post-treatment were the main correlated factors with HRCT features.Conclusion Male RA patients are prone to develop ILD and RA-ILD is susceptible to pulmonary infection.After early treatment,HRCT and quality of life in most patients can be improved.Respiratory symptoms,severity of dyspnea,globulin level,course of disease and vitality of patients are significantly correlated with HRCT.