结缔组织病并发肺间质变31例临床分析.docVIP

精品论文 参考文献 结缔组织病并发肺间质变31例临床分析 山东省聊城市第二人民医院风湿科 临清 山东 聊城 252601 【摘要】目的 研究结缔组织病合并肺间质变的临床特点。方法 回顾性分析154例患者的临床表现、影像学和实验室检查，并对上述资料做对比分析。结果 31例合并肺间质变的结缔组织病中，其中类风湿性关节炎12例，系统性红斑狼疮2例，干燥综合征5例，多发性肌炎/皮肌炎（PM/DM）8例，系统性硬化（SSC）2例，混合性结缔组织病（MCTD）2例；除原发病的表现外，患者气喘、呼吸困难最常见，6例（19.3%），活动后气喘11例（35.5%），进行性呼吸困难3例（9.7%），咳嗽、咳痰2例（6.5%），心悸、胸闷3例（9.7%），体检肺部闻及爆裂音15例（48.4%），胸部CT异常有囊状改变5例（16.1%），结节状阴影8例（25.9%），网状阴影16例（51.7%），小叶间隔增厚2例（6.5%）。31例患者其中26例行肺功能检查，均有肺弥散功能障碍，肺活量和肺总量降低，动脉血气分析（PaO2）lt;60mmHg13例（41.9%），PaCO2不高提示无二氧化碳潴留。31例无1例行纤维支气管镜肺活检；31例经确诊后均给予中至大剂量糖皮质激素联合环磷酰胺治疗，及N-乙酰半胱氨酸（富露施），并辅以对症支持治疗，临床症状完全消退或好转23例，无效7例，死亡1例，死亡原因为呼吸衰竭。结论 我们应提高对风湿性疾病合并肺间质变的认识，以期早期诊断、早期治疗、提高疗效。 【关键词】结缔组织病 肺间质变 肺功能 【中图分类号】R285.6 【文献标识码】A【文章编号】1001-5213(2016)09-0060-02 【 abstract 】 objective to study the clinical characteristics of qualitative change between connective tissue diseases with pulmonary. Methods 154 patients were retrospectively analyzed the clinical, radiological and laboratory examination, and compare to the data analysis. Qualitative difference between the results of 31 cases with pulmonary connective tissue diseases, including rheumatoid arthritis 12 cases, 2 cases of systemic lupus erythematosus (sle) and sjogrens syndrome in 5 cases, multiple myositis/dermatomyositis (PM/DM), 8 cases of systemic sclerosis (SSC) in 2 cases, mixed connective tissue disease (MCTD) in 2 cases; In addition to the performance of the primary disease, the most common in patients with asthma and dyspnea, 6 cases (19.3%), 11 cases (35.5%) after asthma, progressive dyspnea in 3 patients (9.7%), cough, sputum in 2 cases (6.5%), heart palpitations, chest tightness in 3 patients (9.7%), physical examination of lung smell and crackles of 15 cases (48.4%), abnormal chest CT with cystic change in 5 cases (16.1%), nodular shadows 8 cases (25.9%), and reticular shadows in 16 cases (51.7%), interlobular septal thickening (6.5%) in 2 cases. 31 cases of 26 patients with routine lung function, were pulmonary diffuse dysfunction, vital capacity