类风湿关节炎合并肺间质病变临床特点及影响因素研究

Study of Clinical Characteristics and Influencing Factors of Rheumatoid Arthritis Combined with Interstitial Lung Diseases

摘要: 目的：探讨类风湿关节炎(RA)合并肺间质病变(ILD)的临床特点及影响因素。方法：回顾性分析2020年1月至2024年12月期间在菏泽市立医院确诊的213例RA患者的临床资料。根据胸部高分辨CT (HRCT)结果，将患者分为单纯RA组(112例)和RA-ILD组(101例)，收集两组患者的基线资料、实验室指标等，比较两组间各指标的差异性，将具有显著差异的变量纳入多因素Logistic回归模型，分析RA-ILD的独立影响因素。结果：1. 年龄、来氟米特用药史、RF、抗CCP抗体滴度、补体C3、补体C4、免疫球蛋白A、IL-2、IL-4、IL-10、IL-17A、肿瘤坏死因子α在单纯RA组与RA-ILD组间比较，差异有统计学意义(P < 0.05)，其中来氟米特用药史是RA-ILD的危险因素，补体C3、补体C4降低是RA-ILD的危险因素，其他指标升高是RA-ILD的危险因素。2. 年龄、抗CCP抗体、免疫球蛋白A、IL-2是RA患者继发ILD的独立危险因素。结论：年龄、来氟米特用药史、RF、抗CCP抗体滴度、补体C3、补体C4、免疫球蛋白A、IL-2、IL-4、IL-10、IL-17A、肿瘤坏死因子α与RA-ILD的发生发展有关；年龄、抗CCP抗体、免疫球蛋白A、IL-2是RA患者继发ILD的独立危险因素。

Abstract: Objective: To explore the clinical characteristics and influencing factors of rheumatoid arthritis (RA) combined with interstitial lung disease (ILD). Methods: The clinical data of 213 RA patients diagnosed in Heze Municipal Hospital between January 2020 and December 2024 were retrospectively analyzed. Based on the results of high-resolution CT (HRCT) of the chest, the patients were divided into the RA-only group (112 cases) and the RA-ILD group (101 cases). The baseline data and laboratory indexes of the two groups were collected to compare the indexes’ differences, and variables with significant differences were included in the multifactorial Logistic regression model to analyze the independent influencing factors of RA-ILD. Results: 1. Age, history of leflunomide medication, RF, anti-CCP antibody titer, complement C3, complement C4, immunoglobulin A, IL-2, IL-4, IL-10, IL-17A, and tumor necrosis factor-α were compared between the RA-only group and the RA-ILD group, and the differences were statistically significant (P < 0.05), with the history of leflunomide medication being a RA-ILD risk factor, decreased complement C3 and complement C4 were risk factors for RA-ILD, and elevated other indexes were risk factors for RA-ILD. 2. Age, anti-CCP antibody, immunoglobulin A, and IL-2 were independent risk factors for secondary ILD in RA patients. Conclusion: Age, history of leflunomide administration, RF, anti-CCP antibody titer, complement C3, complement C4, immunoglobulin A, IL-2, IL-4, IL-10, IL-17A, and tumor necrosis factor-α were associated with the development of RA-ILD; age, anti-CCP antibody, immunoglobulin A, and IL-2 were independent risk factors for secondary ILD in RA patients.