结缔组织病患者的间质性肺疾病：南非西开普省的亚型、临床特征及合并症
Interstitial lung disease in patients with connective tissue disease: Subtypes, clinical features and comorbidities in the Western Cape, South Africa.
作者信息
Palalane E, Alpizar-Rodriguez D, Botha S, Said-Hartley Q, Calligaro G, Hodkinson B
机构信息
Division of Rheumatology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa.
Research Unit, Mexican College of Rheumatology, Mexico.
出版信息
Afr J Thorac Crit Care Med. 2022 Jul 18;28(2). doi: 10.7196/AJTCCM.2022.v28i2.213. eCollection 2022.
BACKGROUND
Interstitial lung disease (ILD) is highly prevalent in patients with connective tissue disease (CTD) and is poorly characterised in South Africa.
OBJECTIVES
To describe the clinical, serological and radiological features of CTD-ILD and their associations in patients attending a tertiary referral hospital.
METHODS
A cross-sectional study collating clinical, serological and radiological features of CTD-ILD in patients attending rheumatology and respiratory outpatient clinics in a tertiary referral hospital.
RESULTS
Of 124 CTD-ILD patients, 37 (29.8%) had rheumatoid arthritis (RA), 32 (25.8%) systemic sclerosis (SSc) and 55 (44.4%) other autoimmune connective tissue diseases (OCTD). Most patients were female (86.3%), of mixed racial ancestry (75.0%), and the median age was 55 years. Nonspecific interstitial pneumonia (NSIP) was the most common ILD pattern (63.7%), followed by usual interstitial pneumonia (UIP) (26.6%). Overall, 60.5% were current or past smokers, 33.1% had previous pulmonary tuberculosis infection, and 75.6% had gastro-oesophageal reflux disease. Patients with RA were older, had similar frequencies of NSIP and UIP, and had significantly better pulmonary function tests than the SSc and OCTD groups. Within three years of CTD diagnosis, two-thirds of the SSc and OCTD patients and almost half of the RA patients had developed ILD. Clinical features, chest X-rays and pulmonary function tests correlated poorly with high-resolution computerised tomography (HRCT). No case of acute pneumonitis was documented in CTD-ILD patients treated with methotrexate (MTX).
CONCLUSION
We suggest routine HRCT in all newly diagnosed CTD patients, particularly those with SSc and OCTD, where more than two-thirds of the patients had developed ILD within three years of their CTD. The use of MTX was not associated with the development of acute pneumonitis in patients with ILD.
KEY POINTS
Clinical features, chest X-rays and pulmonary function tests correlated poorly with high-resolution computerised tomography (HRCT).Smoking, environmental toxins, gastro-oesophogeal reflux and previous pulmonary tuberculosis infection were significant comorbidities in CTD-ILD patients.Early screening of ILD with HRCT is recommended, particularly in SSc.Use of MTX before and after ILD diagnosis was not associated with acute pneumonitis.
背景
间质性肺疾病（ILD）在结缔组织病（CTD）患者中高度流行，而在南非其特征尚不明确。
目的
描述在一家三级转诊医院就诊的CTD-ILD患者的临床、血清学和放射学特征及其关联。
方法
一项横断面研究，整理在一家三级转诊医院的风湿病科和呼吸科门诊就诊的CTD-ILD患者的临床、血清学和放射学特征。
结果
在124例CTD-ILD患者中，37例（29.8%）患有类风湿关节炎（RA），32例（25.8%）患有系统性硬化症（SSc），55例（44.4%）患有其他自身免疫性结缔组织病（OCTD）。大多数患者为女性（86.3%），具有混合种族血统（75.0%），中位年龄为55岁。非特异性间质性肺炎（NSIP）是最常见的ILD类型（63.7%），其次是普通型间质性肺炎（UIP）（26.6%）。总体而言，60.5%的患者为现吸烟者或既往吸烟者，33.1%曾有肺结核感染，75.6%患有胃食管反流病。RA患者年龄较大，NSIP和UIP的发生率相似，其肺功能测试结果明显优于SSc组和OCTD组。在CTD诊断后的三年内，三分之二的SSc和OCTD患者以及近一半的RA患者发生了ILD。临床特征、胸部X线和肺功能测试与高分辨率计算机断层扫描（HRCT）的相关性较差。接受甲氨蝶呤（MTX）治疗的CTD-ILD患者中未记录到急性肺炎病例。
结论
我们建议对所有新诊断的CTD患者，特别是那些患有SSc和OCTD的患者进行常规HRCT检查，因为在这些患者中，超过三分之二的患者在CTD诊断后的三年内发生了ILD。MTX的使用与ILD患者急性肺炎的发生无关。
关键点
临床特征、胸部X线和肺功能测试与高分辨率计算机断层扫描（HRCT）的相关性较差。吸烟、环境毒素、胃食管反流和既往肺结核感染是CTD-ILD患者的重要合并症。建议早期用HRCT筛查ILD，特别是在SSc患者中。在ILD诊断前后使用MTX与急性肺炎无关。
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