摘要
目的 回顾性分析类风湿关节炎（RA）合并支气管扩张病例资料,探讨其临床特点及相关危险因素.方法 分析自2008年5月至2013年5月入住.北京同仁医院RA合并支气管扩张病例的一般临床特征、肺功能、高分辨率CT等,与同期收治的单一RA病例进行对照分析,并应用Logistic回归探讨相关危险因素.结果 RA患者共计66例,其中RA合并支气管扩张19例,单一RA 47例.RA合并支气管扩张组有呼吸道症状者8例（42.1％）,有呼吸系统体征者8例（42.1％）,RA病程（16.6±9.1）年,呼吸病程（4.6±11.7）年,14例（73.7％）为RA先于支气管扩张发病,平均提前12年.支气管扩张好发于右肺中及下叶,分别为52.6％及36.8％.与单纯RA组相比,RA病程（P=0.045）、PEF（P=0.000）、FEV1.0（P=0.032）、FEF25-75（P=0.002）、DLCO（P=0.008）有显著统计学差异,RA相关免疫指标（RF、APF、CCP）、炎症指标（ESR、CRP）、治疗等方面无差别.多因素分析显示RA病程（P=0.018）及应用来氟米特（P=0.006）具有显著统计学差异.结论 RA人群中支气管扩张并不少见,好发于右肺中下叶,多伴有肺功能异常,RA病程及应用来氟米特为其独立危险因素.
Objective To investigate the clinical characteristics and risk factors of rheumatoid arthritis combined with bronchiectasis （RA-BR） by retrospective analysis of cases. Methods The clinical data of cases diagnosed as RA-BR were compared with those of cases with RA only in Beiing Tongren Hospital from May 2008 to May 2013. A logistic regression analysis was performed to investigate the independent risk factors. Results Sixty-six cases diagnosed as RA were analyzed including 19 cases of RA-BR and 47 cases of RA only. Respiratory manifestation was found in eight cases （8/19, 42.1%） of RA-BR patients with RA duration （16.6 ±9.1） years and respiratory duration （4.6 ±11.7） years. RA proceeding BR was found in 14 cases （14/19, 73.70/00） and the mean duration was about 12 years. BR was mostly located in the right middle lobe and right lower lobe （52.6% and 36.8%）. Compared with RA group, RA duration （ P = 0. 045）, PEF （ P = 0. 000）, FEVI.0 （ P = 0. 032）, FEFzs-T5 （ P = 0. 002） and DLCO （ P =0. 008） were found significant difference in RA-BR group. There was no difference in lab tests between RA-BR and RA group, such as RF, APF, CCP, ANA, SSA, SSB, ESR, and CRP. No difference was found in disease-modifying treatment and corticosteroid usage between these two groups, too. Multivariate analysis showed that RA duration （ P = 0. 018） and using leflunomide （ P = 0. 026） were independent risk factors. Conclusions Bronchiectasis is not unusual in RA patients. The predominant BR distribution is right middle lobe and right lower lobe. The abnormal PFT results are usually found in RA-BR cases including obstructive respiratory dysfunction, small airway dysfunction,and diffusion dysfunction. RA duration and using leflunomide are the independent risk factors.
出处
《国际呼吸杂志》
2013年第18期1387-1391,共5页
International Journal of Respiration
