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目的探讨预测类风湿关节炎(RA)肺间质病变(ILD)预后的有效方法,为RA-ILD的治疗方案选择提供理论依据。方法选择RA-ILD患者61例进行为期12月的观察,入组前、6月、12月后检测肺功能、血气分析、血常规、血沉(ESR)、C反应蛋白(CRP)、类风湿因子(RF)及抗环瓜氨酸肽抗体(CCP-Ab);入组前、12月后均行高分辨CT检测,观察期间出现呼吸道不良事件者行高分辨CT检测;入组前均行肺泡灌洗液(BLAF)检测,观察期间出现明显肺间质病变进展者行BLAF检测。结果 1、入组前BLAF检测发现普通间质性肺炎7例,非特异性间质性肺炎11例,与高分辨肺CT、肺功能联合检测相比阳性率较低;2、61例患者中出现呼吸道不良事件者(呼吸道症状明显加重,且口服抗生素治疗无效者)9例,5例经HRCT发现肺间质呈进展性改变。5例患者行BLAF检测,3例表现为普通间质性肺炎;2例表现为细菌感染;3、BLAF检测普通间质性肺炎、肺功能中重度异常及肺CT受累面积是RA-ILD预后不良独立因素。结论肺功能及肺CT检测较BLAF检测RA-ILD有更高的敏感性,均可对其预后预测,但BLAF检测是明确RA-ILD进展原因更为有效的检查方法。
Objective To explore an effective method for predicting the prognosis of interstitial lung disease (RA) in patients with rheumatoid arthritis (RA), and to provide a theoretical basis for the treatment options of RA-ILD. Methods Sixty-one patients with RA-ILD were enrolled in this study. All patients were enrolled in this study. The pulmonary function, blood gas analysis, ESR, C-reactive protein (CRP), rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (CCP-Ab). High-resolution CT was performed before and after 12 months. High-resolution CT was used to detect adverse respiratory events during the observation period. Lavage fluid (BLAF) test, observed during the development of obvious interstitial lung disease were performed BLAF test. Results 1, 7 cases of common interstitial pneumonia and 11 cases of nonspecific interstitial pneumonia were found in the BLAF test before enrollment, which was lower than that of high-resolution lung CT and pulmonary function test. Among the 261 patients Respiratory adverse events (respiratory symptoms were significantly worse, and oral antibiotics ineffective treatment) in 9 cases, 5 cases of pulmonary interstitial progress was found by HRCT changes. 5 patients underwent BLAF test, 3 cases showed common interstitial pneumonia; 2 cases showed bacterial infection; 3, BLAF detected common interstitial pneumonia, moderate and severe lung function and pulmonary CT involvement area is poor prognosis of RA-ILD Independent factors. Conclusions Lung function and lung CT detection are more sensitive than BLAF in detecting RA-ILD. All of them can predict the prognosis of RA-ILD. However, BLAF detection is a more effective method to identify the cause of RA-ILD.