类风湿关节炎肺间质病变中医证型与肺部高分辨CT和肺功能的关系
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摘要
目的:探讨类风湿关节炎肺间质病变中医证型与肺部高分辨CT和肺功能的关系。方法:收集207例类风湿关节炎肺间质病变患者的临床资料,根据中医辨证分为肺肾气阴两虚证、肺肾气虚证、肺脾气虚证和肾阳虚证4个证型,对各个证型与肺部高分辨CT和肺功能的相关性进行研究。结果:207例患者中肺肾气阴两虚证最多(45.9%),肾阳虚证最少(11.1%)。对各个证型在肺HRCT不同阶段的比例数比较发现:在肺HRCT 1期阶段,肾阳虚证>肺肾气虚证>肺脾气虚证>肺肾气阴两虚证;在肺HRCT 2期阶段,肾阳虚证>肺肾气阴两虚证>肺脾气虚证>肺肾气虚证;在肺HRCT 3期阶段,肺肾气阴两虚证>肺脾气虚证>肺肾气虚证>肾阳虚证。肺功能方面:在肺功能轻度下降阶段,肾阳虚证>肺脾气虚证>肺肾气虚证>肺肾气阴两虚证;在肺功能中度下降阶段,肺肾气阴两虚证>肺肾气虚证>肺脾气虚证>肾阳虚证;在肺功能重度下降阶段,肺肾气阴两虚证>肺肾气虚证>肺脾气虚证>肾阳虚证。结论:肺肾气阴两虚证是RA-ILD的主要证候类型,肾阳虚证最少见;肺肾气阴两虚证多见于肺HRCT的2期和3期阶段,肺功能的中、重度下降阶段,程度最重;肾阳虚证多见于肺HRCT的1期和2期阶段,肺功能的轻、中度下降阶段,程度最轻。
Objective:The purpose of this study was to explore the correlation between lung high resolution computed tomography(lung HRCT)or pulmonary function and Chinese medical syndrome types of rheumatoid arthritis-interstitial lung disease(RA-ILD).Methods:The clinical data of 207 patients with RA-ILD were collected.Then,the correlation between lung HRCT and pulmonary function and Chinese medical syndrome was researched.Results:The proportion of the patients with lung-kidney Qi-yin deficiency syndrome was the most(45.9%)and the proportion of the patients with kidney Yang deficiency syndrome was the least(11.1%).In the first stage of lung HRCT,the proportion of the patients with kidney Yang deficiency syndrome was the most and the proportion of lung-kidney Qi-Yin deficiency syndrome was the least.In the second stage of lung HRCT,the proportion of the patients with kidney Yang deficiency syndrome was the most and the proportion of lung-kidney Qi deficiency syndrome was he least.In the third stage of lung HRCT,the proportion of the patients with lung-kidney Qi-Yin deficiency syndrome was the most and the proportion of kidney Yang deficiency syndrome was the least.In the light stage of pulmonary function,the proportion of the patients with kidney Yang deficiency syndrome was the most and the proportion of lung-kidney Qi-Yin deficiency syndrome was the least.In the moderate stage of pulmonary function,the proportion of the patients with lung-kidney Qi-Yin deficiency syndrome was the most and the proportion of kidney Yang deficiency syndrome was the least.In the severe stage of pulmonary function,the result was similar as well as the moderate stage.Conclusion:The lung-kidney Qi-Yin deficiency syndrome is the most universal and worst in the three stages of lung HRCT or pulmonary function in RA-ILD.Meanwhile,the kidney Yang deficiency syndrome is the least and lightest.
Objective:The purpose of this study was to explore the correlation between lung high resolution computed tomography(lung HRCT)or pulmonary function and Chinese medical syndrome types of rheumatoid arthritis-interstitial lung disease(RA-ILD).Methods:The clinical data of 207 patients with RA-ILD were collected.Then,the correlation between lung HRCT and pulmonary function and Chinese medical syndrome was researched.Results:The proportion of the patients with lung-kidney Qi-yin deficiency syndrome was the most(45.9%)and the proportion of the patients with kidney Yang deficiency syndrome was the least(11.1%).In the first stage of lung HRCT,the proportion of the patients with kidney Yang deficiency syndrome was the most and the proportion of lung-kidney Qi-Yin deficiency syndrome was the least.In the second stage of lung HRCT,the proportion of the patients with kidney Yang deficiency syndrome was the most and the proportion of lung-kidney Qi deficiency syndrome was he least.In the third stage of lung HRCT,the proportion of the patients with lung-kidney Qi-Yin deficiency syndrome was the most and the proportion of kidney Yang deficiency syndrome was the least.In the light stage of pulmonary function,the proportion of the patients with kidney Yang deficiency syndrome was the most and the proportion of lung-kidney Qi-Yin deficiency syndrome was the least.In the moderate stage of pulmonary function,the proportion of the patients with lung-kidney Qi-Yin deficiency syndrome was the most and the proportion of kidney Yang deficiency syndrome was the least.In the severe stage of pulmonary function,the result was similar as well as the moderate stage.Conclusion:The lung-kidney Qi-Yin deficiency syndrome is the most universal and worst in the three stages of lung HRCT or pulmonary function in RA-ILD.Meanwhile,the kidney Yang deficiency syndrome is the least and lightest.
引文
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[12] Horton MR.Rheumatoid arthritis associated interstitial lung disease[J].Crit Rev Comput Tomogr,2004,45(5/6):429-440.
[13] Assayag D,Lubin M,Lee JS,et al.Predictors of mortality in rheumatoid arthritis-related interstitial lung disease[J].Respirology,2014,19(4):493-500.
[14] 李松伟,李素云,郭洪涛,等.类风湿关节炎相关肺间质病变中医证候特征回顾性分析[J].中华中医药杂志,2013,28(4):1077-1080.
[15] Wang T,Zheng XJ,Liang BM,et al.Clinical features of rheumatoid arthritis-associated interstitial lung disease[J].Sci Rep,2015,5:14897.
[16] 周浩彤,王友莲.类风湿关节炎合并肺间质病变的影响因素研究[J].中国全科医学,2017,20(10):1191-1195.
[17] Johnson C.Recent advances in the pathogenesis,prediction,and management of rheumatoid arthritis-associated interstitial lung disease.Curr Opin Rheumatol,2017,29(3):254-259.
[18] Paulin F,Doyle TJ,Fletcher EA,et al.Rheumatoid Arthritis-Associated Interstitial Lung Disease and Idiopathic Pulmonary Fibrosis:Shared Mechanistic and Phenotypic Traits Suggest Overlapping Disease Mechanisms[J].Rev Invest Clin,2015,67(5):280-286.
[19] 李松伟,王济华,杨科朋,等.类风湿关节炎肺间质病变患者的中医证候特征[J].中医杂志,2015,56(19):1655-1658.
[2] Hamblin MJ,Horton MR.Rheumatoid arthritis-associated interstitial lung disease:diagnostic dilemma[J].Pulm Med,2011,2011:872120.
[3] Solomon JJ,Chung JH,Cosgrove GP,et al.Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease[J].Eur Respir J,2016,47(2):588-596.
[4] 马大庆,李铁一,关砚生,等.肺间质病变的高分辨率CT表现及其病理基础和诊断意义[J].中华放射学杂志,1999,33(2):101-105.
[5] Assayag D1,Elicker BM,Urbania TH,et al.Rheumatoid arthritis-associated interstitial lung disease:radiologic identification of usual interstitial pneumonia pattern[J].Radiology,2014,270(2):583-588.
[6] Amett FC,Edworth SM,Bloch DA,et al.The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J].Arthritis Rheum,1988,31(3):315-324.
[7] The American Thoracic Society and the European Respiratory Society.ATS/ERS international multidisciplinary consensus classification of the idiopathic interstitial pneumonias[J].Eur Respir J,2002,19(5):794-796.
[8] 中国中医研究院.中医证候鉴别诊断学[M].北京:人民卫生出版社,2002:235-248.
[9] 中华中医药学会肺系病专业委员会.弥漫性间质性肺疾病的中医证候诊断标准(2012版)[J].中医杂志,2012,53(13):1163-1165.
[10] 邱建国,潘解萍,喻少波,等.结缔组织病肺间质病变高分辨率CT分期的临床价值[J].实用放射学杂志,2008,24(9):1188-1190.
[11] 王国俊,李泽庚,彭波,等.肺气虚证患者肺功能分级研究[J].中医杂志,2010,51(3):259-261.
[12] Horton MR.Rheumatoid arthritis associated interstitial lung disease[J].Crit Rev Comput Tomogr,2004,45(5/6):429-440.
[13] Assayag D,Lubin M,Lee JS,et al.Predictors of mortality in rheumatoid arthritis-related interstitial lung disease[J].Respirology,2014,19(4):493-500.
[14] 李松伟,李素云,郭洪涛,等.类风湿关节炎相关肺间质病变中医证候特征回顾性分析[J].中华中医药杂志,2013,28(4):1077-1080.
[15] Wang T,Zheng XJ,Liang BM,et al.Clinical features of rheumatoid arthritis-associated interstitial lung disease[J].Sci Rep,2015,5:14897.
[16] 周浩彤,王友莲.类风湿关节炎合并肺间质病变的影响因素研究[J].中国全科医学,2017,20(10):1191-1195.
[17] Johnson C.Recent advances in the pathogenesis,prediction,and management of rheumatoid arthritis-associated interstitial lung disease.Curr Opin Rheumatol,2017,29(3):254-259.
[18] Paulin F,Doyle TJ,Fletcher EA,et al.Rheumatoid Arthritis-Associated Interstitial Lung Disease and Idiopathic Pulmonary Fibrosis:Shared Mechanistic and Phenotypic Traits Suggest Overlapping Disease Mechanisms[J].Rev Invest Clin,2015,67(5):280-286.
[19] 李松伟,王济华,杨科朋,等.类风湿关节炎肺间质病变患者的中医证候特征[J].中医杂志,2015,56(19):1655-1658.