Pulmonary involvement in patients with early rheumatoid arthritis
Pulmonary involvement in patients with early rheumatoid arthritis
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DOI：
10.1080/03009740701393957
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发表时间：
2007-01-01
影响因子：
2.1
通讯作者：
Efremidis, S. C.
中科院分区：
文献类型：
--
作者：
Metafratzi, Z. M.;Georgiadis, A. N.;Efremidis, S. C.
目的：应用高分辨率CT(HRCT)评价早期类风湿关节炎(RA)患者的胸膜肺改变。方法：43例非吸烟早期类风湿关节炎患者入选。病程1年，未做过治疗。使用28关节指数评分(DAS28)评估疾病活动性。手部和手腕X光片采用Larsen标准进行评估。对32例患者进行肺功能检查。对患者和18例非吸烟者健康体检者进行胸部X线平片(CXR)和肺部HRCT检查。结果：HRCT显示气滞者占69%(25/36)，支气管扩张占58%(25/43)，支气管壁增厚占52%(22/43)，磨玻璃样阴影占35%(15/43)。胸膜增厚、积液发生率为11%(5/43)。1例患者CXR异常，显示单个肺结节。GGOS是唯一仅在RA患者中观察到的HRCT征象。所有其他异常在对照组中以与患者相同的频率出现。然而，患者组的空气嵌顿、支气管扩张和支气管壁增厚的程度(以HRCT评分表示)明显大于对照组(p<；0.05)。PFT均在正常值范围内。DAS28、PFTs和Larsen评分分别与每个HRCT征象评分或总分没有显示出任何显著的相关性。结论：早期RA患者在HRCT上常可观察到肺部异常，即使在CXR和PFT正常时也是如此。GGO的有限区域是仅在患者身上描述的异常。
Objectives: To assess the pleuropulmonary changes in patients with early rheumatoid arthritis ( RA), using high-resolution computed tomography ( HRCT). Methods: Forty- three non- smoking patients with early RA were included. The disease duration was < 1 year, without previous treatment. Disease activity was assessed using the 28- joint indices score ( DAS28). Hand and wrist X- rays were evaluated using Larsen's criteria. Pulmonary functional tests ( PFTs) were performed in 32 patients. The patients and 18 non- smokers healthy individuals were assessed by plain chest X- ray ( CXR) and HRCT of the lungs. Results: HRCT revealed air trapping in 69% ( 25/ 36), bronchiectasis in 58% ( 25/ 43), bronchial wall thickening in 52% ( 22/ 43) and ground glass opacities ( GGOs) in 35% ( 15/ 43) of the patients. Pleural thickening and effusion were observed in 11% ( 5/ 43). CXR was abnormal in one patient revealing a single pulmonary nodule. GGOs were the only HRCT sign observed exclusively in RA patients. All the other abnormalities were depicted in the control group at the same frequency as in the patients. However, the extent ( as expressed by the HRCT score) of air trapping, bronchiectasis and bronchial wall thickening was significantly greater in the patients than in the control group ( p < 0.05). The PFTs were within normal values. DAS28, PFTs, and the Larsen score did not show any significant correlation with either each HRCT sign score separately or the total score. Conclusions: Lung abnormalities are frequently observed in patients with early RA on HRCT, even when CXR and PFTs are normal. Limited areas of GGOs were the abnormalities depicted exclusively in patients.