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1、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%
2、),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%)031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)<60mmHgl3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
3、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】objectivetostudytheclinicalcharacteristicsofqualitativechangebetween
4、connectivetissuediseaseswithpulmonary.Methods154patientswereretrospectivelyanalyzedtheclinical,radiologicalandlaboratoryexamination,andcomparetothedataanalysis.Qualitativediffereneebetweentheresultsof31caseswithpulmonarycormectivetissuediseases,includingrh
5、eumatoidarthritis12cases,2casesofsystemiclupuserythematosus(sle)andsjogren'ssyndromein5cases,multiplemyositis/dermatomyositis(PM/DM),8casesofsystemicsclerosis(SSC)in2cases,mixedconnectivetissuedisease(MCTD)in2cases;Inadditiontotheperformaneeoftheprimarydis
6、ease,themostcommoninpatientswithasthmaanddyspnea,6cases(19.3%),11cases(35.5%)afterasthma,progressivedyspneain3patients(9.7%),cough,sputumin2cases(6.5%),heartpalpitations,chesttightnessin3patients(9.7%),physicalexaminationoflungsmellandcracklesof15cases(48.
7、4%),abnormalchestCTwithcysticchangein5cases(16.1%),nodularshadows8cases(25.9%),andreticularshadowsin16cases(51.7%),interlobularseptalthickening(6.5%)in2cases・31casesof26patientswithroutinelungfunction,werepulmonarydiffusedysfunction,vitalcapacityandlungvol
8、umeisreduced,arterialbloodgasanalysis(PaO2)<mmhgl360cases(41.9%),highPaCO2don'ttipwithoutcarbondioxideretention.31caseswithno1lungroutinefiberopticbronchoscopybiopsy;In31caseswereperformedafterconfirmedtoh
