回顾性分析类风湿性关节炎相关间质性肺病中医证型特征及疾病早发影响因素

Retrospective analysis on characteristics of traditional Chinese medicine syndrome and influence factors related to early onset of rheumatoid arthritis-associated interstitial lung disease

关键词:  类风湿性关节炎  间质性肺病  中医证型  影响因素

Key words:  rheumatoid arthritis  interstitial lung disease  traditional Chinese medicine syndrome  influence factor

摘要:

[目的] 探讨类风湿性关节炎-相关间质性肺病（RA-ILD）的中医证型特征和影响RA-ILD早发的风险因素。[方法] 筛选RA-ILD住院电子病历，提取性别、年龄、吸烟史、症状、体征、RA中医证型、RA诊断时间、RA-ILD诊断时间和胸部高分辨率CT（HRCT）特征等资料，采用回顾性分析，评价RA-ILD发病时间、病理学分型和早发影响因素。[结果] 筛选130例，剔除11例，纳入研究119例，其中肝肾阴虚型54例、气血两虚型36例、风湿热郁型19例、风寒湿阻型10例。发病时间比较，全部病例平均发病时间约11 a，中位发病时间约7 a，平均和中位发病时间均呈风湿热郁型<风寒湿阻型<气血两虚型<肝肾阴虚趋势，差异均有统计学意义（P<0.05）；病理学分型以普通性间质性肺炎（UIP，65.5%）和非特异性间质性肺炎（NSIP，30.3%）为主，风湿热郁型（52.6%）和肝肾阴虚型（96.3%）UIP发生率高，风寒湿阻型（90.0%）和气血两虚型（55.6%）NSIP发生率高，组间比较，差异均有统计学意义（P<0.05）。多因素Cox比例风险回归分析，RA中医证型是RA-ILD早发（≤ 7 a）的影响因素，RA实证与虚证相比，RA-ILD早发风险增加约2倍（HR 2.972，95%CI：1.775，4.976）。[结论] RA中医分型与RA-ILD病理类型有一定对应关系，风湿热郁型和风寒湿阻型RA更易早发RA-ILD，该结论尚需前瞻性研究确证。

Abstract:

[Objective] To investigate the characteristics of traditional Chinese medicine (TCM) syndrome and influence factors related to early onset of rheumatoid arthritis-associated interstitial lung disease (RA-ILD).[Methods] Clinical data, such as gender, age, smoking history, symptoms and signs, TCM syndrome, diagnostic time for RA and RA-ILD and characteristics of chest HRCT, of inpatient with RA-ILD, were analyzed retrospectively. Onset time, pathological types and influence factors related to early onset of RA-ILD were evaluated.[Results] A total of 130 patients were filtered and 11 patients were deleted. So 119 patients were identified, of whom 54 liver-kidney yin deficiency type, 36 asthenia of qi and blood type, 19 beriberoid pyretic arthralgia type and 10 wind-cold-damp retention type. The mean and median onset time respectively were 11 years and 7 years of these patients, and both of them showed a trend as beriberoid pyretic arthralgia type < wind-cold-damp retention type < asthenia of qi and blood type < liver-kidney yin deficiency type with significant differences. UIP (65.5%) and NSIP (30.3%) were the main pathological types. Iincidence rate of beriberoid pyretic arthralgia type (52.6%) and liver-kidney yin deficiency type(96.3%) in UIP and wind-cold-damp retention type(90.0%) and asthenia of qi and blood type(55.6%) in NSIP were significant higher. The results of multivariate Cox proportional hazards regression analysis showed that TCM syndrome of RA was the influence factor related to early onset(≤ 7 years) of RA-ILD, and excess syndrome of RA raised the risk two times.[Conclusion] There is a certain degree of correlation between TCM syndrome of RA and pathological type of RA-ILD, and onset times of RA-ILD of beriberoid pyretic arthralgia type and wind-cold-damp retention type are earlier than the other types. This conclusion should be further confirmed by prospective studies.