国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
International Journal of Respiration
2015年
16期
1213-1218
,共6页
结缔组织病%间质性肺疾病%肺动脉高压%心脏彩超%肺CT/HRCT%肺功能
結締組織病%間質性肺疾病%肺動脈高壓%心髒綵超%肺CT/HRCT%肺功能
결체조직병%간질성폐질병%폐동맥고압%심장채초%폐CT/HRCT%폐공능
Connective tissue disease%Interstitial lung disease%Pulmonary hypertension%Ultrasonic cardiogram%Pulmonary CT/HRCT%Lung function
目的 分析结缔组织病(connective tissue disease,CTD)相关间质性肺疾病(interstitial lung disease,ILD)继发肺动脉高压(pulmonary hypertension,PH)的临床表现、肺功能、肺部CT/HRCT、血气及实验室检查等临床资料,探讨CTD-ILD继发PH的特点.方法 回顾性分析557例CTD-ILD患者的临床资料,比较CTD-ILD-PH组与CTD-ILD组的临床特点.结果 ①CTD继发ILD的发病率为27.65％,CTD-ILD发生PH的发病率为13.11％;②CTD-ILD继发PH原发病的发病率由高到低依次为:重叠综合征、混合性结缔组织病、系统性硬化症、系统性红斑狼疮、原发性干燥综合征、多发性肌炎/皮肌炎及类风湿关节炎;③CTD-ILD-PH组患者咳痰、气短、呼吸困难、雷诺现象、皮肤变硬的发生率及静息心率均高于CTD-ILD组(P值均＜0.05);④CTD-ILD-PH组的肺部CT/H RCT中磨玻璃密度影、网格影、小叶间隔增厚、肺动脉干增粗、心影增大及胸腔积液的发生率高于CTD-ILD组(P值均＜0.05);⑤CTD-ILD-PH组肺功能指标FVC％pred、DL CO％ pred及血气指标PaO2均低于CTD-ILD组(P值均＜0.05);⑥CTD-ILD-PH组心脏彩超提示右室内径、右室流出道内径、肺动脉内径及三尖瓣反流速度高于CTD-ILD组(P值均＜0.05);⑦ANA抗体及SM抗体阳性者更易继发PH.结论 ①CTD继发ILD的发病率为27.65％,CTD-ILD发生PH的发病率为13.11％.②重叠综合征、混合性结缔组织病合并ILD时较其他CTD患者更易继发PH;③当CTD-ILD患者出现咳痰、气短、呼吸困难、雷诺现象及心率增快症状时,应完善相关检查,警惕PH的发生;④肺CT/HRCT发现网格影、小叶间隔增厚、肺动脉干增粗及心影增大或心脏超声提示右室大、三尖瓣反流速度增高,应监测肺动脉压;⑤CTD-ILD患者肺功能FVC％pred、DL CO％ pred及血气PaO2下降明显时,注意发生PH;⑥ANA及SM抗体可作为预测CTD-ILD-PH简单、易行的指标.
目的 分析結締組織病(connective tissue disease,CTD)相關間質性肺疾病(interstitial lung disease,ILD)繼髮肺動脈高壓(pulmonary hypertension,PH)的臨床錶現、肺功能、肺部CT/HRCT、血氣及實驗室檢查等臨床資料,探討CTD-ILD繼髮PH的特點.方法 迴顧性分析557例CTD-ILD患者的臨床資料,比較CTD-ILD-PH組與CTD-ILD組的臨床特點.結果 ①CTD繼髮ILD的髮病率為27.65％,CTD-ILD髮生PH的髮病率為13.11％;②CTD-ILD繼髮PH原髮病的髮病率由高到低依次為:重疊綜閤徵、混閤性結締組織病、繫統性硬化癥、繫統性紅斑狼瘡、原髮性榦燥綜閤徵、多髮性肌炎/皮肌炎及類風濕關節炎;③CTD-ILD-PH組患者咳痰、氣短、呼吸睏難、雷諾現象、皮膚變硬的髮生率及靜息心率均高于CTD-ILD組(P值均＜0.05);④CTD-ILD-PH組的肺部CT/H RCT中磨玻璃密度影、網格影、小葉間隔增厚、肺動脈榦增粗、心影增大及胸腔積液的髮生率高于CTD-ILD組(P值均＜0.05);⑤CTD-ILD-PH組肺功能指標FVC％pred、DL CO％ pred及血氣指標PaO2均低于CTD-ILD組(P值均＜0.05);⑥CTD-ILD-PH組心髒綵超提示右室內徑、右室流齣道內徑、肺動脈內徑及三尖瓣反流速度高于CTD-ILD組(P值均＜0.05);⑦ANA抗體及SM抗體暘性者更易繼髮PH.結論 ①CTD繼髮ILD的髮病率為27.65％,CTD-ILD髮生PH的髮病率為13.11％.②重疊綜閤徵、混閤性結締組織病閤併ILD時較其他CTD患者更易繼髮PH;③噹CTD-ILD患者齣現咳痰、氣短、呼吸睏難、雷諾現象及心率增快癥狀時,應完善相關檢查,警惕PH的髮生;④肺CT/HRCT髮現網格影、小葉間隔增厚、肺動脈榦增粗及心影增大或心髒超聲提示右室大、三尖瓣反流速度增高,應鑑測肺動脈壓;⑤CTD-ILD患者肺功能FVC％pred、DL CO％ pred及血氣PaO2下降明顯時,註意髮生PH;⑥ANA及SM抗體可作為預測CTD-ILD-PH簡單、易行的指標.
목적 분석결체조직병(connective tissue disease,CTD)상관간질성폐질병(interstitial lung disease,ILD)계발폐동맥고압(pulmonary hypertension,PH)적림상표현、폐공능、폐부CT/HRCT、혈기급실험실검사등림상자료,탐토CTD-ILD계발PH적특점.방법 회고성분석557례CTD-ILD환자적림상자료,비교CTD-ILD-PH조여CTD-ILD조적림상특점.결과 ①CTD계발ILD적발병솔위27.65％,CTD-ILD발생PH적발병솔위13.11％;②CTD-ILD계발PH원발병적발병솔유고도저의차위:중첩종합정、혼합성결체조직병、계통성경화증、계통성홍반랑창、원발성간조종합정、다발성기염/피기염급류풍습관절염;③CTD-ILD-PH조환자해담、기단、호흡곤난、뢰낙현상、피부변경적발생솔급정식심솔균고우CTD-ILD조(P치균＜0.05);④CTD-ILD-PH조적폐부CT/H RCT중마파리밀도영、망격영、소협간격증후、폐동맥간증조、심영증대급흉강적액적발생솔고우CTD-ILD조(P치균＜0.05);⑤CTD-ILD-PH조폐공능지표FVC％pred、DL CO％ pred급혈기지표PaO2균저우CTD-ILD조(P치균＜0.05);⑥CTD-ILD-PH조심장채초제시우실내경、우실류출도내경、폐동맥내경급삼첨판반류속도고우CTD-ILD조(P치균＜0.05);⑦ANA항체급SM항체양성자경역계발PH.결론 ①CTD계발ILD적발병솔위27.65％,CTD-ILD발생PH적발병솔위13.11％.②중첩종합정、혼합성결체조직병합병ILD시교기타CTD환자경역계발PH;③당CTD-ILD환자출현해담、기단、호흡곤난、뢰낙현상급심솔증쾌증상시,응완선상관검사,경척PH적발생;④폐CT/HRCT발현망격영、소협간격증후、폐동맥간증조급심영증대혹심장초성제시우실대、삼첨판반류속도증고,응감측폐동맥압;⑤CTD-ILD환자폐공능FVC％pred、DL CO％ pred급혈기PaO2하강명현시,주의발생PH;⑥ANA급SM항체가작위예측CTD-ILD-PH간단、역행적지표.
Objective To study the clinical features of connective tissue disease (CTD) with interstitial lung disease (ILD) complicating pulmonary hypertension (PH).Methods The clinical data of 557 cases of CTD-ILD were retrospectively analyzed,the clinical characteristics of CTD-ILD-PH group and CTD-ILD group were compared.Results ① The incidence rate of ILD secondary to CTD was 27.65％,the prevalence rate of CTD-ILD-induced PH was 13.11％.②The primary diseases in PH secondary to CTD-ILD according to prevalence rate from high to low were:overlap syndrome,mixed connective tissue disease,systemic sclerosis,systemic lupus erythematosus,primary desiccation syndrome,polymyositis/dermatomyositis,and rheumatoid arthritis.③ The incidence rates of expectoration,breathless,dyspnea,Raynaud's phenomenon,skin hardens,and resting heart rate of CTD-ILD-PH group were higher than those of CTD-ILD group (all P ＜0.05).④The incidence rates of ground-glass opacity,grid shadow,interlobular septal thickening,thickening of pulmonary artery,heart enlargement and pleural effusion in pulmonary CT/HRCT of CTD-ILD-PH group were higher than those of CTD-ILD group (all P ＜ 0.05).⑤FVC％pred,DLCO％pred,and PaO2 in CTD-ILD-PH group were lower than those in CTD-ILD group (all P ＜ 0.05).⑥ The echocardiography showed that the incidence rates of right ventricular diameter,right ventricular outflow tract diameter,pulmonary artery diameter and three tricuspid regurgitation velocity in CTD-ILD-PH group were higher than those in CTD-ILD group (all P ＜0.05).⑦ The positive ANA and SM antibodies were prone to secondary PH.Conclusions ①The incidence rate of ILD secondary to CTD is 27.65％,the prevalence rate of CTD-ILD-induced PH is 13.11％.②Overlap syndrome or mixed connective tissue disease combined with ILD is more likely to complicating PH than other CTD.③When the CTD-ILD patients have expectoration,breathless,dyspnea,Raynaud' s phenomenon,skin hardens and increased heart rate,the relevant inspection should be improved,the occurrence of PH should be alerted.④When the lung CT/HRCT shows grid shadow,interlobular septal thickening,pulmonary artery thickening or cardiac ultrasound shows right ventricle enlargement or increased three tricuspid regurgitation velocity,the pulmonary artery pressure should monitored.⑤When FVC％pred,DLCO％ pred and PaO2 obviously decrease in patients with CTD-ILD,PH should be paied attention to.⑥ ANA and SM antibodied can be used to predict CTD-ILD-PH as simple and feasible indexes.
