中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2008年
7期
513-516
,共4页
目的 探讨原发性干燥综合征(pSS)患者肺部病变的临床特点.方法 回顾性分析1985至2005年在北京协和医院确诊的pSS患者522例,按肺部病变[肺部影像学异常、肺功能下降或超声心动图肺动脉收缩压隐隐约约≥40 mm Hg(1 mm Hg=0.133 kPa)]将522例患者分为肺部病变组和无肺部病变组,对两组的临床特点进行分析.采用SPSS 13.0统计学软件包对正态分布的计量资料行t检验,偏态分布的计量资料行非参数检验,计数资料行卡方检验.结果 (1)522例患者中有肺部病变者221例(42.3%),多见于发病后48个月.肺部病变组发病年龄[(43±13)岁]晚于无肺部病变组[(37±14)岁](t=-5.445,P=0.000);肺部病变组口干、眼干及猖獗齿较无肺部病变组更常见(分别为89.6%,/35 81.1%,χ2=7.145,P=0.008;78.7%vs 66.4%,χ2=9.472,P=0.002;55.2%vs42.2%,χ2=8.647,P=0.003).(2)522例患者中最常见的pSS肺部病变是问质性肺病(116例,23.2%),其次是肺动脉高压(44例,12.5%).(3)11例行肺组织病理检测患者中5例为非特异性间质性肺炎,3例为淋巴细胞间质性肺炎.(4)肺部病变组更常出现雷诺现象、低热、关节肿、抗U1RNP抗体及高γ球蛋白血症(分别为26.7% vs 13.0%,χ2=15.77,P=0.000;20.4%vs 13.0%,χ2=5.175,P=0.023;29.4%vs21.6%,χ2=4.164,P=0.041),而肾小管酸中毒少见(5.4%vs12.6%,χ2=7.616,P=0.006).(5)pSS肺部病变可增加死亡风险达5.5倍,感染是最常见的死亡原因(9例).结论 肺部病变是pSS常见的系统损害,严重影响疾病预后,因此,确诊pSS的患者均应进一步明确肺部病,变情况.
目的 探討原髮性榦燥綜閤徵(pSS)患者肺部病變的臨床特點.方法 迴顧性分析1985至2005年在北京協和醫院確診的pSS患者522例,按肺部病變[肺部影像學異常、肺功能下降或超聲心動圖肺動脈收縮壓隱隱約約≥40 mm Hg(1 mm Hg=0.133 kPa)]將522例患者分為肺部病變組和無肺部病變組,對兩組的臨床特點進行分析.採用SPSS 13.0統計學軟件包對正態分佈的計量資料行t檢驗,偏態分佈的計量資料行非參數檢驗,計數資料行卡方檢驗.結果 (1)522例患者中有肺部病變者221例(42.3%),多見于髮病後48箇月.肺部病變組髮病年齡[(43±13)歲]晚于無肺部病變組[(37±14)歲](t=-5.445,P=0.000);肺部病變組口榦、眼榦及猖獗齒較無肺部病變組更常見(分彆為89.6%,/35 81.1%,χ2=7.145,P=0.008;78.7%vs 66.4%,χ2=9.472,P=0.002;55.2%vs42.2%,χ2=8.647,P=0.003).(2)522例患者中最常見的pSS肺部病變是問質性肺病(116例,23.2%),其次是肺動脈高壓(44例,12.5%).(3)11例行肺組織病理檢測患者中5例為非特異性間質性肺炎,3例為淋巴細胞間質性肺炎.(4)肺部病變組更常齣現雷諾現象、低熱、關節腫、抗U1RNP抗體及高γ毬蛋白血癥(分彆為26.7% vs 13.0%,χ2=15.77,P=0.000;20.4%vs 13.0%,χ2=5.175,P=0.023;29.4%vs21.6%,χ2=4.164,P=0.041),而腎小管痠中毒少見(5.4%vs12.6%,χ2=7.616,P=0.006).(5)pSS肺部病變可增加死亡風險達5.5倍,感染是最常見的死亡原因(9例).結論 肺部病變是pSS常見的繫統損害,嚴重影響疾病預後,因此,確診pSS的患者均應進一步明確肺部病,變情況.
목적 탐토원발성간조종합정(pSS)환자폐부병변적림상특점.방법 회고성분석1985지2005년재북경협화의원학진적pSS환자522례,안폐부병변[폐부영상학이상、폐공능하강혹초성심동도폐동맥수축압은은약약≥40 mm Hg(1 mm Hg=0.133 kPa)]장522례환자분위폐부병변조화무폐부병변조,대량조적림상특점진행분석.채용SPSS 13.0통계학연건포대정태분포적계량자료행t검험,편태분포적계량자료행비삼수검험,계수자료행잡방검험.결과 (1)522례환자중유폐부병변자221례(42.3%),다견우발병후48개월.폐부병변조발병년령[(43±13)세]만우무폐부병변조[(37±14)세](t=-5.445,P=0.000);폐부병변조구간、안간급창궐치교무폐부병변조경상견(분별위89.6%,/35 81.1%,χ2=7.145,P=0.008;78.7%vs 66.4%,χ2=9.472,P=0.002;55.2%vs42.2%,χ2=8.647,P=0.003).(2)522례환자중최상견적pSS폐부병변시문질성폐병(116례,23.2%),기차시폐동맥고압(44례,12.5%).(3)11례행폐조직병리검측환자중5례위비특이성간질성폐염,3례위림파세포간질성폐염.(4)폐부병변조경상출현뢰낙현상、저열、관절종、항U1RNP항체급고γ구단백혈증(분별위26.7% vs 13.0%,χ2=15.77,P=0.000;20.4%vs 13.0%,χ2=5.175,P=0.023;29.4%vs21.6%,χ2=4.164,P=0.041),이신소관산중독소견(5.4%vs12.6%,χ2=7.616,P=0.006).(5)pSS폐부병변가증가사망풍험체5.5배,감염시최상견적사망원인(9례).결론 폐부병변시pSS상견적계통손해,엄중영향질병예후,인차,학진pSS적환자균응진일보명학폐부병,변정황.
Objective To evaluate the incidence, clinieal manifestations and immunological features of lung involvement in patients of primary Sjogren's syndrome (pSS). Methods Five hundred twenty-two patients with pSS in Peking Union Medical College Hospital between 1985 and 2005 were screened retrospectively for lung involvement by either the "abnormalities of chest imaging, lung function or the pulmonary artery systolic pressure estimated by ultrasonic echocardiogram ≥40 mm Hg ( 1 mm Hg = 0. 133 kPa), excluding infections, chronic obstructive pulmonary disease,asthma, congenital heart disease, rheumatic heart disease and other diseases. The difference was compared between patients with and without lung involvement. Alpatients fulfilled the 2002 international classification (criteria) for pSS. Results(1) The incidence of lung involvement in pSS was 42.3% (221/522) and occurred from 0 to 384 months (median, 48 months) after onset, while 25.2% occurred before the diagnosis of pSS. Only 47. 1% of the patients showed respiratory symptoms. The average age of onset was older in patients with lung involvement than in those without lung involvement [(43 ± 13)yr vs (37 ± 14)yr, t = -5.445, P = 0.000]. Incidences of dry mouth (89. 6% vs 81.1% ,χ2 =7. 145, P = 0. 008), dry eyes (78.7% vs 66. 4% ,χ2 = 9. 472, P = 0. 002 ) and rampant caries (55.2% vs 42. 2% , χ2 = 8. 647, P = 0. 003 ) were higher in patients with lung involvement than those without. There was no significant difference in sex ratio between the two groups.(2) Interstitial lung disease was the most common lung involvement and occurred in 23.2% of the patients. Pulmonary artery hypertension in 12. 5%, multiple pulmonary bullae in 9. 2%, pleural effusion in 6. 0% and multiple pulmonary nodules in 5.6%.(3) The major histopathologieal patterns were nonspecific interstitial pneumonia ( 5/11 eases),lymphocytic interstitial pneumonia ( 3/11 cases).(4) Incidences of Ranaud ' s phenomenon ( 26.7% vs 13.0%, χ2 = 15.77, P = 0. 000 ) , low-grade fever (20.4% vs 13.0% ,χ2=5. 175, P =0. 023), arthrosis (29.4% vs 21.6% ,χ2 =4.164, P=0. 041), anti- U1RNP (18.2% vs 11.2%,χ2 =5.069, P=0.024) and hypergammaglobulinemia (51.6% vs 39.5%, χ2 =6. 597,P =0.01 )were higher in patients with lung involvement than in those without. The incidence of renal tubule acidosis was lower in patients with lung involvement than in those without (5.4% vs 12. 6%, χ2 =7. 616, P =0.006). (5) The death incidence in pSS with pulmonary involvement was 5. 5 times higher than in those without. The most frequent cause of death was infection ( 64.3% ), especially pulmonary infection. Conclusion Lung involvement in pSS is common. As it is an important factor related to the prognosis of this disease, chest X-ray, HRCT, lung function and ultrasonic echocardiogram after the diagnosis are suggested.
