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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (2): 266-272. doi: 10.19723/j.issn.1671-167X.2021.02.006

• 论著 • 上一篇    下一篇

系统性红斑狼疮伴间质性肺炎的临床特点及相关因素分析

夏芳芳1,鲁芙爱1,吕慧敏1,杨国安2,Δ(),刘媛3,Δ()   

  1. 1.风湿免疫科, 内蒙古科技大学包头医学院第一附属医院, 内蒙古自治区包头 014010
    2.中心试验室, 内蒙古科技大学包头医学院第一附属医院, 内蒙古自治区包头 014010
    3.台州市第一人民医院风湿免疫科, 浙江台州 318000
  • 收稿日期:2019-03-24 出版日期:2021-04-18 发布日期:2021-04-21
  • 通讯作者: 杨国安,刘媛 E-mail:0331004@163.com;liuyuanem@163.com
  • 基金资助:
    内蒙古自治区自然科学基金(2017MS(LH)0812);包头医学院科学研究基金(BYJJ-YF 2016100)

Clinical characteristics and related factors of systemic lupus erythematosus with interstitial pneumonia

XIA Fang-fang1,LU Fu-ai1,LV Hui-min1,YANG Guo-an2,Δ(),LIU Yuan3,Δ()   

  1. 1. Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia, China
    2. Central Laboratory, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia, China
    3. Department of Rheumatology, Taizhou First People’s Hospital, Taizhou 318000, Zhejiang, China
  • Received:2019-03-24 Online:2021-04-18 Published:2021-04-21
  • Contact: Guo-an YANG,Yuan LIU E-mail:0331004@163.com;liuyuanem@163.com
  • Supported by:
    Natural Science Foundation of Inner Mongolia(2017MS(LH)0812);Research Funds of Baotou Medical College(BYJJ-YF 2016100)

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摘要：

目的: 探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)伴间质性肺疾病(interstitial lung disease,ILD)患者的临床特点、影像评分及疾病相关危险因素。方法: 收集2015年1月至2019年3月于包头医学院第一附属医院和台州市第一人民医院风湿免疫科住院且行肺高分辨率计算机断层扫描(high resolution computed tomography,HRCT)检查的60例SLE患者的临床资料,采用1 ∶1配比病例对照研究,两组患者年龄、性别匹配,其中SLE-ILD组的30例为病例组,SLE non-ILD(无ILD)组的30例为对照组。分析SLE-ILD患者的临床特点、影像学特征和肺HRCT评分,并分析SLE-ILD的相关危险因素。结果: 两组相比,胸闷/气短、雷诺现象、Velcro啰音差异有统计学意义(P<0.05);SLE-ILD组比SLE non-ILD组患者的血红蛋白及白蛋白有明显下降趋势,而尿素氮、红细胞沉降率、C反应蛋白、IgG这4个指标有上升趋势,差异有统计学意义(P<0.05);SLE-ILD患者最常见的类型为非特异性间质性肺炎,依次为普通型间质性肺炎和淋巴细胞间质性肺炎;不同ILD分型的临床-影像-生理评分之间比较,差异无统计学意义(P>0.05);不同ILD分型的肺HRCT评分及肺功能之间比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,胸闷/气短、白蛋白下降是SLE-ILD发生的危险因素。结论: SLE患者出现胸闷/气短、低白蛋白血症要警惕ILD的发生,非特异性间质性肺炎是SLE-ILD最常见的表现类型。

关键词: 系统性红斑狼疮, 间质性肺疾病, 临床特点, 危险因素

Abstract:

Objective: To investigate the clinical features, radiologic scores and clinically relevant risk factors prognosis of secondary interstitial lung disease (ILD) in patients with systemic lupus erythematosus (SLE). Methods: In this study, 60 SLE patients in Department of Rheumatology of the First Affiliated Hospital of Baotou Medical College and Taizhou First People’s Hospital from January 2015 to March 2019 were retrospectively analyzed. All of those 60 patients with SLE underwent lung high resolution computed tomography (HRCT) examination. We used a 1 ∶1 case-control study. There was a matching of age and gender between the two groups. Thirty patients with SLE related ILD (SLE-ILD) were in the case group, and 30 patients with SLE without ILE (SLE non-ILD) were in the control group. The clinical features, pulmonary function test, radiologic characteristic of SLE patients were collected and were used to analyze SLE-ILD. Results: In this study, we reached the following conclusions: First, there were statistically significant differences in chest tightness/shortness of breath, Raynaud’s phenomenon, and Velcro rale between SLE-ILD and SLE non-ILD patients (both P<0.05); Second, hemoglobin (Hb) and albumin (ALB) in the patients of SLE-ILD had a significant decrease compared with the patients of SLE non-ILD. Blood urea nitrogen (BUN), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased in SLE-ILD patients compared with SLE non-ILD patients, the difference had statistical significance (P<0.05); Third, for SLE-ILD patients, the most common type was non-specific interstitial pneumonia (NSIP), followed by usual interstitial pneumonia and lymphocytic interstitial pneumonia; Fourth, there was no significant difference in clinical-radiology-physiology scores between the different ILD types (P>0.05), similarly, the lung HRCT score and lung function between different ILD types had no significant difference (P>0.05); Fifth, multivariate Logistic regression analysis showed that decreased albumin and chest tightness/shortness of breath might be the risk factor for SLE-ILD. Conclusion: There are statistically significant differences between the SLE-ILD group and SLE non-ILD group in terms of chest tightness/shortness of breath, Velcro rale and Raynaud’s phenomenon. Decreased albumin and chest tightness/shortness of breath in SLE patients should be alerted to the occurrence of ILD. NSIP is the most common manifestation of SLE-ILD.

Key words: Systemic lupus erythematosus, Interstitial lung diseases, Clinical features, Risk factors

中图分类号: 

  • R593.24

表1

SLE-ILD与SLE non-ILD患者的临床表现比较"

Clinical
manifestation		 Fever, n (%) Dry cough, n (%) Chest tightness,
n (%)		 Chest pain, n (%) Velcro, n (%) Clubbing, n (%)
Yes No Yes No Yes No Yes No Yes No Yes No
SLE-ILD 16 (53) 14 (47) 9 (30) 21 (70) 22 (73) 8 (27) 2 (6) 28 (94) 18 (60) 12 (40) 3 (10) 27 (90)
SLE non-ILD 14 (47) 16 (53) 9 (30) 21 (70) 12 (40) 18 (60) 3 (10) 27 (90) 10 (33) 20 (67) 1 (3) 29 (97)
χ2 0.267 0.000 6.787 0.000 4.286 0.268
P 0.606 1.000 0.009# >0.999 0.038* 0.605
Clinical
manifestation		 Rash, n (%) Arthritis, n (%) Oral ulcer,
n (%)		 Raynaud’s
phenomenon,
n (%)		 Light allergy,
n (%)		 Myalgia/muscle
weakness, n (%)		 Hair loss,
n (%)
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
SLE-ILD 15 (50) 15 (50) 17 (56) 13 (44) 10 (33) 20 (67) 17 (56) 13 (44) 1 (3) 29 (97) 16 (53) 14 (47) 10 (33) 20 (67)
SLE non-ILD 16 (53) 14 (47) 19 (63) 11 (37) 9 (30) 21 (70) 8 (26) 22 (74) 6 (20) 24 (80) 15 (50) 15 (50) 5 (16) 25 (84)
χ2 0.067 0.278 0.077 5.554 2.588 0.067 2.222
P 0.796 0.598 0.781 0.018* 0.108 0.796 0.136

表2

SLE-ILD与SLE non-ILD患者的实验室检查指标($\bar{x} \pm s$)"

Items SLE-ILD (n=30) SLE non-ILD (n=30) F P
WBC/(×109 cells/L) 6.04±2.04 5.75±1.99 0.305 0.583
Hb/(g/L) 121.73±24.27 135.03±14.25 6.700 0.012*
PLT/(×109 cells/L) 178.23±84.84 194.80±75.36 0.639 0.427
ALT/(U/L) 24.76±20.23 25.06±12.67 0.005 0.944
ALB/(g/L) 38.02±9.83 42.27±4.24 4.726 0.034*
BUN/(mmol/L) 9.90±8.94 6.34±2.91 4.303 0.042*
Scr/(μmol/L) 96.84±58.40 69.70±21.07 5.722 0.020*
C3/(g/L) 0.85±0.28 0.93±0.24 1.301 0.259
C4/(g/L) 0.20±0.09 0.18±0.08 1.674 0.201
IgA/(g/L) 3.03±1.12 3.10±1.23 0.054 0.817
IgM/(g/L) 0.64±0.34 0.75±0.47 1.133 0.292
IgG/(g/L) 14.02±5.24 11.76±2.97 4.219 0.044*

表3

SLE-ILD与SLE non-ILD患者的实验室检查指标[M (P25, P75)]"

Items SLE-ILD SLE non-ILD Statistics P
UTP 0.30 (0.00, 0.97) 0.00 (0.00, 0.21) -0.673 0.501
ESR 55 (15, 114) 8 (7, 15) -10.822 <0.001
CRP 48.80 (12.20, 57.00) 4.18 (3.13, 8.98) -12.427 <0.001

表4

SLE-ILD与SLE non-ILD患者的自身抗体"

Group ANA dsDNA Sm SSA
(Ro-52 kDa)		 SSA
(60 kDa)		 SSB RNP nRNP/Sm
+ - + - + - + - + - + - + - + -
SLE-ILD, n 28 2 16 14 13 17 14 16 15 15 8 22 8 22 15 15
SLE non-ILD, n 26 4 15 15 10 20 9 21 12 18 4 26 13 17 15 15
χ2 0.185 0.067 0.635 0.184 0.436 0.938 1.832 0.000
P 0.667 0.796 0.426 1.763 0.606 0.333 0.176 >0.999

表5

SLE-ILD患者不同ILD分型的临床-影像-生理评分、肺HRCT评分及肺功能比较($\bar{x} \pm s$)"

Items Clinical-radiology-physiology score HRCT score FVC/(%pred) DLCO/(%pred)
UIP 19.29±8.34 2.43±2.15 90.71±25.76 66.71±14.95
NSIP 19.00±12.73 1.00±0.62 69.00±29.70 53.00±39.60
F 0.002 0.748 1.056 0.704
P 0.97 0.42 0.34 0.43

表6

SLE-ILD与SLE non-ILD患者的系统受累表现"

Group Blood system, n (%) Renal system, n (%) Nervous system, n (%) Cardiovascular system, n (%)
Yes No Yes No Yes No Yes No
SLE-ILD 23 (77) 7 (23) 10 (33) 20 (67) 4 (13) 26 (87) 6 (20) 24 (80)
SLE non-ILD 21 (70) 9 (30) 15 (50) 15 (50) 2 (7) 28 (93) 7 (23) 23 (77)
χ2 0.559 0.190 0.667 0.754
P 0.341 1.714 0.185 0.098

表7

SLE-ILD相关危险因素的单因素Logistic回归分析结果"

Items B SE P
Chest tightness 0.339 0.125 0.009
Raynaud’s phenomenon 0.309 0.127 0.018
Velcro 0.268 0.127 0.039
Hb↓ 0.417 0.155 0.009
ALB↓ 0.501 0.156 0.002
BUN↑ 0.278 0.129 0.035
CRP↑ 0.39 0.162 0.019
ESR↑ 0.144 0.135 0.292
IgG -0.032 0.015 0.044

表8

SLE-ILD相关危险因素的多因素Logistic回归分析结果"

Items B SE Wald P OR 95%CI
Chest tightness 1.570 0.624 6.323 0.012 4.808 1.414-16.348
Albumin ↓ 2.848 1.137 6.276 0.012 17.255 1.859-160.185
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CN 11-4691/R
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