CAJ | 학술논문

目的：分析结缔组织相关性间质性肺疾病(CTD-ILD)和特发性间质性肺疾病(IIP)合并肺血栓栓塞症(PTE)患者的临床特征。方法收集2011~2014年在广州呼吸疾病研究所住院的CTD-ILD合并PTE及IIP合并PTE的患者17例(ILD合并PTE组)，并募集同期肺通气功能相匹配的CTD-ILD及IIP共20例患者(单纯ILD组)作为对照，对其临床资料进行分析。并在此基础上再对比ILD合并PTE组中的CTD-ILD亚组及IIP亚组。结果①与单纯ILD组比较，在ILD合并PTE组中，患者出现近期新发呼吸困难或呼吸困难加重的发生率有增高的趋势；ILD合并PTE组的动脉血氧分压更低，分别为(76.4±22.3)mmHg和(63.4±19.2)mmHg(P<0.05)；气体交换功能(DLCO%预计值)更差，分别为(48.5±11.6)%和(37.9±12.8)%。②ILD合并PTE组中，CTD-ILD亚组和IIP亚组的平均年龄分别为(59.83±13.40)岁和(71.90±4.68)岁，病程中出现PTE症状的时间分别为(18.07±16.71)个月和(34.75±14.69)个月，CTD-ILD患者发病年龄更小(P<0.05)，病程中出现PTE症状的时间更短(P<0.05)；IIP亚组患者共5例(71.43%)出现下肢水肿，CTD-ILD亚组中没有患者出现下肢水肿；IIP亚组中3例(30.00%)患者长期口服糖皮质激素，而CTD-ILD亚组共5例(71.43%)患者长期口服糖皮质激素。结论 ILD合并PTE可使患者气体交换功能障碍进一步加重，CTD本身的发生进展和长期口服糖皮质激素是PTE发生的高危因素。与IIP合并PTE比较，CTD-ILD合并PTE患者起病年龄更小，出现PTE的病程更短。
목적：분석결체조직상관성간질성폐질병(CTD-ILD)화특발성간질성폐질병(IIP)합병폐혈전전새증(PTE)환자적림상특정。방법수집2011~2014년재엄주호흡질병연구소주원적CTD-ILD합병PTE급IIP합병PTE적환자17례(ILD합병PTE조)，병모집동기폐통기공능상필배적CTD-ILD급IIP공20례환자(단순ILD조)작위대조，대기림상자료진행분석。병재차기출상재대비ILD합병PTE조중적CTD-ILD아조급IIP아조。결과①여단순ILD조비교，재ILD합병PTE조중，환자출현근기신발호흡곤난혹호흡곤난가중적발생솔유증고적추세；ILD합병PTE조적동맥혈양분압경저，분별위(76.4±22.3)mmHg화(63.4±19.2)mmHg(P<0.05)；기체교환공능(DLCO%예계치)경차，분별위(48.5±11.6)%화(37.9±12.8)%。②ILD합병PTE조중，CTD-ILD아조화IIP아조적평균년령분별위(59.83±13.40)세화(71.90±4.68)세，병정중출현PTE증상적시간분별위(18.07±16.71)개월화(34.75±14.69)개월，CTD-ILD환자발병년령경소(P<0.05)，병정중출현PTE증상적시간경단(P<0.05)；IIP아조환자공5례(71.43%)출현하지수종，CTD-ILD아조중몰유환자출현하지수종；IIP아조중3례(30.00%)환자장기구복당피질격소，이CTD-ILD아조공5례(71.43%)환자장기구복당피질격소。결론 ILD합병PTE가사환자기체교환공능장애진일보가중，CTD본신적발생진전화장기구복당피질격소시PTE발생적고위인소。여IIP합병PTE비교，CTD-ILD합병PTE환자기병년령경소，출현PTE적병정경단。
Objective To study the clinical characteristics of pulmonary thromboembolism in connective tissue disease related interstitial lung disease (CTD-ILD) and the idiopathic interstitial pneumonia (IIP) respectively. Methods From 2011 to 2014, 17 ILD (CTD-ILD and IIP) patients with pulmonary thromboembolism (PTE) in Guangzhou Institute of Respiratory Disease were retrospectively analyzed. 20 simplex ILD (CTD-ILD and IIP) patients with well-matched lung function were also recruited as control group during the same period. The clinical data and symptoms were summarized and statistically calculated. And a further analysis of clinical difference between CTD-ILD with PTE subgroup and IIP with PTE subgroup was followed. Results ①Compared with simplex ILD group, incidence of new dyspnea or aggravation of dyspnea was higher in ILD with PTE group; arterial partial pressure of oxygen was significantly lower in ILD with PTE group (P< 0.05), which were (76.4±22.3) mmHg and (63.4±19.2) mmHg respectively. And a significant lower pulmonary diffusion function (DLCO% of the predicted values) was found in ILD with PE group, which were (48.5±11.6)% and (37.9±12.8)% respectively (P< 0.05). ②In ILD with PTE group, average age of CTD-ILD and IIP subgroups were (59.83±13.40) years and (71.90±4.68) years The occurrence of PTE were (18.07±16.71) months and (34.75±14.69) months. It indicated that the age at onset of CTD-ILD was younger than IIP (P < 0.05), and the occurrence of PTE during ILD course was earlier than IIP. No patients of CTD-ILD subgroup had edema of lower limbs, while 5 patients (71.43%) of IIP subgroup had the symptom. 3 patients (30.00%) of IIP subgroup had oral adminstration of corticosteroids histories, while 5 patients (71.43%) of CTD-ILD subgroup had oral adminstra-tion of corticosteroids histories. Conclusion Association of PTE can aggravate pulmonary diffusion dysfunction. Occu-rance and progression of CTD and long-term oral adminstration of corticosteroids are all high risk factors of PTE. Compared with IIP patients with PTE, CTD-ILD patients with PTE are younger and have a shorter course of PTE onset.