中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2015年
5期
306-312
,共7页
高辉%何菁%张学武%张霞%冯敏%陈丽君%安媛%李玉慧%杨月
高輝%何菁%張學武%張霞%馮敏%陳麗君%安媛%李玉慧%楊月
고휘%하정%장학무%장하%풍민%진려군%안원%리옥혜%양월
干燥综合征%危险因素%肺%体层摄影术,X线
榦燥綜閤徵%危險因素%肺%體層攝影術,X線
간조종합정%위험인소%폐%체층섭영술,X선
Sj(o)gren's syndrome%Risk factors%Lung%Tomography,X-ray
目的 本研究旨在研究pSS患者的肺脏受累情况,并分析其影像学特点,探讨pSS患者发生肺脏受累的危险因素,为pSS患者肺脏受累的诊断及预后评估提供依据.方法 选取2003-2012年北京大学人民医院住院的1 341例SS患者,其中pSS患者853例,继发性SS(sSS)患者488例,分析患者的临床及影像学资料,以其中105例pSS肺脏受累患者为研究对象纳入病例组,选取同期(2008-2012年)84例不合并脏器受累的pSS患者作为对照组,根据美国胸科协会/欧洲呼吸协会(ATS/ERS)特发性间质性肺炎的分类,由2名经验丰富的放射科医师判断pSS肺脏受累的高分辨率CT(HRCT)异常类型、发生部位及肺叶受损面积评分.利用横断面研究探讨pSS患者肺脏受累患者HRCT的受损面积、分布部位及常见类型,利用病例对照分析及Logistic回归探讨肺脏受累危险因素.结果 SS患者肺脏受累发生率为21.70％(291/1341),其中19.34％(165/853) pSS和25.82％(126/488)sSS患者出现肺脏累及.高球蛋白血症及RF升高在该人群中明显,但抗SSA抗体、抗SSB抗体阳性率仅分别为52.5％和37.8％.pSS肺脏受累患者的HRCT分析示肺脏受累范围广泛,肺下叶受累比例高且肺叶受损面积大.常见HRCT异常类型为线样影(61例,93.8％)、磨玻璃样(57例,87.7％)、胸膜受累(42例,64.6％)、网格状样(41例63.1％)等.病例对照分析发现年龄≥60岁、C4低于正常、RF和ANA阳性的肺脏受累患者所占比例更高,然而,抗SSA阳性患者所占比例更低,差异均有统计学意义(x2=42.338,P＜0.01;x2=3.681,P=0.05;x2=14.171,P＜0.01;x2=10.507,P＜0.01;x2=4.435,P=0.04).多元Logistic回归示年龄≥ 60岁(OR=7.73)及RF阳性(OR=4.43)为pSS患者发生肺脏受累的独立危险因素(均P＜0.01).结论 肺脏受累是pSS患者的常见合并症,肺病变广泛且类型多样,下叶受累比例高且受损面积大.高龄及RF阳性为pSS肺脏受累的独立危险因素.
目的 本研究旨在研究pSS患者的肺髒受纍情況,併分析其影像學特點,探討pSS患者髮生肺髒受纍的危險因素,為pSS患者肺髒受纍的診斷及預後評估提供依據.方法 選取2003-2012年北京大學人民醫院住院的1 341例SS患者,其中pSS患者853例,繼髮性SS(sSS)患者488例,分析患者的臨床及影像學資料,以其中105例pSS肺髒受纍患者為研究對象納入病例組,選取同期(2008-2012年)84例不閤併髒器受纍的pSS患者作為對照組,根據美國胸科協會/歐洲呼吸協會(ATS/ERS)特髮性間質性肺炎的分類,由2名經驗豐富的放射科醫師判斷pSS肺髒受纍的高分辨率CT(HRCT)異常類型、髮生部位及肺葉受損麵積評分.利用橫斷麵研究探討pSS患者肺髒受纍患者HRCT的受損麵積、分佈部位及常見類型,利用病例對照分析及Logistic迴歸探討肺髒受纍危險因素.結果 SS患者肺髒受纍髮生率為21.70％(291/1341),其中19.34％(165/853) pSS和25.82％(126/488)sSS患者齣現肺髒纍及.高毬蛋白血癥及RF升高在該人群中明顯,但抗SSA抗體、抗SSB抗體暘性率僅分彆為52.5％和37.8％.pSS肺髒受纍患者的HRCT分析示肺髒受纍範圍廣汎,肺下葉受纍比例高且肺葉受損麵積大.常見HRCT異常類型為線樣影(61例,93.8％)、磨玻璃樣(57例,87.7％)、胸膜受纍(42例,64.6％)、網格狀樣(41例63.1％)等.病例對照分析髮現年齡≥60歲、C4低于正常、RF和ANA暘性的肺髒受纍患者所佔比例更高,然而,抗SSA暘性患者所佔比例更低,差異均有統計學意義(x2=42.338,P＜0.01;x2=3.681,P=0.05;x2=14.171,P＜0.01;x2=10.507,P＜0.01;x2=4.435,P=0.04).多元Logistic迴歸示年齡≥ 60歲(OR=7.73)及RF暘性(OR=4.43)為pSS患者髮生肺髒受纍的獨立危險因素(均P＜0.01).結論 肺髒受纍是pSS患者的常見閤併癥,肺病變廣汎且類型多樣,下葉受纍比例高且受損麵積大.高齡及RF暘性為pSS肺髒受纍的獨立危險因素.
목적 본연구지재연구pSS환자적폐장수루정황,병분석기영상학특점,탐토pSS환자발생폐장수루적위험인소,위pSS환자폐장수루적진단급예후평고제공의거.방법 선취2003-2012년북경대학인민의원주원적1 341례SS환자,기중pSS환자853례,계발성SS(sSS)환자488례,분석환자적림상급영상학자료,이기중105례pSS폐장수루환자위연구대상납입병례조,선취동기(2008-2012년)84례불합병장기수루적pSS환자작위대조조,근거미국흉과협회/구주호흡협회(ATS/ERS)특발성간질성폐염적분류,유2명경험봉부적방사과의사판단pSS폐장수루적고분변솔CT(HRCT)이상류형、발생부위급폐협수손면적평분.이용횡단면연구탐토pSS환자폐장수루환자HRCT적수손면적、분포부위급상견류형,이용병례대조분석급Logistic회귀탐토폐장수루위험인소.결과 SS환자폐장수루발생솔위21.70％(291/1341),기중19.34％(165/853) pSS화25.82％(126/488)sSS환자출현폐장루급.고구단백혈증급RF승고재해인군중명현,단항SSA항체、항SSB항체양성솔부분별위52.5％화37.8％.pSS폐장수루환자적HRCT분석시폐장수루범위엄범,폐하협수루비례고차폐협수손면적대.상견HRCT이상류형위선양영(61례,93.8％)、마파리양(57례,87.7％)、흉막수루(42례,64.6％)、망격상양(41례63.1％)등.병례대조분석발현년령≥60세、C4저우정상、RF화ANA양성적폐장수루환자소점비례경고,연이,항SSA양성환자소점비례경저,차이균유통계학의의(x2=42.338,P＜0.01;x2=3.681,P=0.05;x2=14.171,P＜0.01;x2=10.507,P＜0.01;x2=4.435,P=0.04).다원Logistic회귀시년령≥ 60세(OR=7.73)급RF양성(OR=4.43)위pSS환자발생폐장수루적독립위험인소(균P＜0.01).결론 폐장수루시pSS환자적상견합병증,폐병변엄범차류형다양,하협수루비례고차수손면적대.고령급RF양성위pSS폐장수루적독립위험인소.
Objective To evaluate the prevalence of lung involvement in primary Sj(o)gren's syndrome (pSS) patients,and analyze its radiological high-resolution computed tomography (HRCT) characteristics and risk factors for lung impairments.Methods A total of 1 341 hospitalized SS patients from 2003 to 2012 were retrospectively reviewed.The prevalence of pulmonary involvement was calculated.Among them,105 pSS patients (2008-2012) with lung complication and 84 without systemic damage were further explored.Demographic data,laboratory tests and arterial blood test (ABG) were obtained from medical charts.The HRCT scans were re-evaluated by two experienced chest radiologists.HRCT score of each lobe was assessed based on the percentage of affected lung parenchyma.The distribution and common types of lung involvement were evaluated by cross-section study.Case control study and Logistic regression were performed to explore the risk factors of lung involvement in pSS patients.Results Among the 1 341 hospitalized patients (853 with pSS and 488 with sSS),165 patients (19.34％) from pSS group and 126 patients (25.82％) from sSS group presented lung involvement.Hyperglobulinemia (IgG) and elevated RF were prominent,however,anti-SSA and anti-SSB were positive in only 52.5％ and 37.8％ patients,respectively.For the 36 patients who took ABG,20 presented with hypoxemia and 7 with type 1 respiratory failure.Lower lung lobes involvement was more frequent and more severe.The most common HRCT findings were linear opacities (61 cases,93.8％),ground-glass attenuation (57 cases,87.7％),pleural involvement (42 cases,64.6％) and reticular pattern (41 cases,63.1％).Compared with the control group,percentages of patients from age ≥ 60 year,low C4,elevated RF (OR=4.43)and ANA positivity were significantly higher (x2=42.338,P＜0.01;x2=3.681,P=0.05;x2=14.171,P＜0.01;x2=10.507,P＜0.01),whereas,those of anti-SSA positivity was significantly lower (x2=4.435,P=0.042).Advanced age (≥60 year) (OR=7.73) and elevated RF (OR=4.43) were retained as independent correlated factors after adjusting for all the factors with significant difference (P＜0.01).Conclusion Lung involvement is a severe and common complication for pSS patients.Advanced age and RF positivity are independent risk factors for pulmonary complications in pSS patients.
