摘要
目的:挖掘干燥综合征合并肺间质病变(SS-ILD)与未合并肺间质病变(SS-NILD)住院患者之间的临床差异,为SS-ILD的早期诊断及后续临床治疗提供客观理论支持。方法:收集符合标准的SS-ILD和SS-NILD住院患者的临床资料,对基本信息、临床表现、证型舌脉、实验室检查、治疗方案等进行统计分析。结果:共纳入299例患者,其中SS-ILD组87例,SS-NILD组212例。SS-ILD组年龄、有烟酒史、有呼吸系统症状、舌苔无或剥脱、脉象弱的概率较高,氧分压水平较低,红细胞沉降率、C反应蛋白水平及类风湿因子阳性率较高;辨证为阴虚津亏、气阴两虚、燥瘀互结的患者合并ILD的比例较高(P<0.05)。回归分析结果表明:合并ILD与吸烟史、主诉咳嗽、舌苔无或剥脱、弱脉及气阴两虚证呈正相关,与主诉眼干呈负相关。SS-ILD肺功能检查以轻度阻塞性/限制性通气功能障碍和轻度弥散功能障碍为主,胸部高分辨CT主要表现为胸膜增厚、结节影、磨玻璃影。SS-ILD所用中成药以虫草类制剂为主,SS-NILD以雷公藤类制剂为主;西医用药以免疫抑制剂为主,或与中效糖皮质激素联合应用。结论:SS住院患者多为高龄中老年女性,有吸烟史及呼吸系统症状、中医辨证为气阴两虚是合并ILD的相关因素,临床用药以抗炎、调节免疫为目标,生物制剂仍需进一步推广应用。
Objective:To explore the clinical differences between inpatients with Sj gren′s syndrome and interstitial lung disease(SS-ILD)and those without interstitial lung disease(SS-NILD),providing objective theoretical support for the early diagnosis and subsequent clinical treatment of SS-ILD.Methods:Clinical data from inpatients with SS-ILD and SS-NILD meeting the inclusion criteria were collected.Statistical analysis was conducted on basic information,clinical manifestations,syndrome types based on tongue and pulse diagnosis,laboratory tests,and treatment regimens.Results:A total of 299 patients were included,with 87 in the SS-ILD group and 212 in the SS-NILD group.The SS-ILD group had a higher probability of being older,having a history of smoking and alcohol use,experiencing respiratory symptoms,having no or desquamated tongue coating,and having weak pulses.This group also had lower oxygen partial pressure,higher erythrocyte sedimentation rate,C-reactive protein levels,and rheumatoid factor positivity rates.Patients diagnosed with the syndromes of yin deficiency with fluid depletion,qi and yin deficiency,and dryness in combination with stasis had a higher likelihood of ILD(P<0.05).Regression analysis indicated that ILD was positively correlated with smoking history,cough as the primary complaint,no or desquamated tongue coating,weak pulse,and qi-yin deficiency syndrome,and negatively correlated with dry eye as the primary complaint.Pulmonary function tests in the SS-ILD group mainly showed mild obstructive/restrictive ventilatory dysfunction and mild diffusion dysfunction.High-resolution chest CT in SS-ILD patients primarily showed pleural thickening,nodular shadows,and ground-glass opacities.The main Chinese patent medicines used in the SS-ILD group were formulas containing Cordyceps,while the SS-NILD group predominantly used Tripterygium wilfordii-based preparations.Western medicine treatments were mainly immunosuppressants,or a combination of intermediate-acting glucocorticoids.Conclusion:Hospitalized SS patients are primarily elderly women with a smoking history and respiratory symptoms.Traditional Chinese medicine diagnosis of qi-yin deficiency is associated with the presence of ILD.Clinical treatment focuses on anti-inflammatory and immune-regulatory therapies,with further promotion of biologics still needed.
作者
郭子琳
周新尧
唐晓颇
GUO Zilin;ZHOU Xinyao;TANG Xiaopo(Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)
出处
《世界中医药》
北大核心
2024年第19期2993-3003,3007,共12页
World Chinese Medicine
基金
中央级公益性科研院所基本科研业务费专项(ZZ15-YQ-023)
中国中医科学院科技创新工程项目(CI2021A01510,CI2021A01502)
中国中医科学院自主选题项目(ZZ11-029,ZZ15-XY-PT-11)。
关键词
干燥综合征
肺间质病变
住院患者
临床特点
治疗方案
中医舌脉
中医证型
回顾性研究
Sj gren′s syndrome
Interstitial lung disease
Inpatients
Clinical characteristics
Treatment plan
Traditional Chinese medicine tongue and pulse
Traditional Chinese medicine syndrome types
Retrospective research
