老年类风湿关节炎肺功能变化及其相关性

类风湿关节炎专题基金项目:国家中医药管理局科研课题专项基金(04 05LP 27);安徽省十一五攻关项目(0701*******);安徽科技重点研究项目(06023068);安徽现代中医内科应用基础与开发研究省级实验室建设项目(科条[2008]150号);安徽省教育厅自然科学重点科研项目(K J2008A165)作者简介:刘健,博士,主任医师,教授,博士生导师,主要从事中医药防治风湿病研究,E ma i:l li u jianahzy @yahoo .co 老年类风湿关节炎肺功能变化及其相关性刘健,万磊,盛长健,谢秀丽(安徽中医学院第一附属医院风湿免疫科,合肥230031)[摘要] 目的 研究老年类风湿关节炎(PA )患者肺功能变化及与其他指标的相关性。

方法 将66例RA 患者按年龄分为中青年类风湿关节炎(YM RA )、老年类风湿关节炎(ERA )两组,采用肺功能仪检测两组RA 患者的肺功能变化,并与健康对照组(N C)进行比较;观察两组RA 患者的生活质量、焦虑(S A S)和抑郁(SD S)、社会支持评定(SS R S)量表、健康指数(HAQ )、疾病活动度评分(DAS 28)及临床症状、体征及实验室指标的变化。

结果(1)在66例RA 患者中,YM RA 占71.2%,ERA 占28.8%;与健康对照组比较可知,RA患者肺功能异常率最高的为FEF 75(66.7%),其次为FEF 50、M VV 、FEF 25;ERA 组FEF 75异常率达74.4%,PEF 、M VV 异常率分别为73.4%、57.9%。

(2)与NC 组比较,YM RA 组、ERA 组V C 、FE V 1、FV C 、MVV 、FEF 25、FEF 50、FEF 75、PEF 明显降低(P <0.01)。

与YM RA 组相比,ERA 组SSRS 、双手握力数、ASO 、CD 4+CD 25+CD 127-T reg 降低(P <0.05);生理功能积分、社会功能积分、心理功能积分、健康认识积分、生活质量总积分、SAS 、SDS 、HAQ 、关节肿胀、关节压痛、中医症候总积分、血清铁、X 胸片分级显著升高(P <0.05或P <0.01)。

(3)Spear m an 相关分析结果显示,ERA 组患者肺功能参数FEV 1与晨僵呈正相关,FEF 25与关节压痛呈正相关(P <0.05);VC 、FVC 与15m 步行时间呈负相关,FE V 1、PEF 与关节压痛呈负相关,MVV 与DA S 28呈负相关,FEF 50与关节压痛、15m 步行时间呈负相关,FEF 75与补体C3呈负相关(P <0.05或P <0.01)。

结论 类风湿关节炎患者随着年龄的增长,其肺功能水平显著下降,表现为小气道功能的严重损伤,并伴有混合性通气功能障碍。

[关键词] 关节炎,类风湿;肺通气;肺活量;危险因素[中图分类号]R 593.22 [文献标识码]A[文章编号]1672 6790(2010)01 0004 05S tudy on the pu l monary function changes i n patien ts w ith el d erly on set rh eumatoi d arth ritis and the ir corre lati on LIU J ian ,WAN Lei ,S HEN Chang j i an ,X IE X iu li(D epart m ent of Rheu m atology,the F i r stA ff iliated H o sp ital of T rad itional ChineseM edica l Universit y of A nhui Province ,H e f ei 230031,China )[Abstract] O bjective T o st udy the pu l m onary f unction changes i n the e l derly patients w ith rheu m ato i d ar t h ritis and the i r co rre lati on .M ethod s 66pati ents w ith rheuma t o id arthritis(RA )pa ti entsw ere d i v i ded i nto young and m i dd l e aged patients w ith rheuma to i d a rt hr iti s(YM RA ),elde rl y onse t rheum ato i d a rt hr iti s (ERA )t w o g roups ,usi ng t wo sets o f pu l m onary functi on de tected by changes in l ung functi on i n patients w it h RA,and compared w it h nor m a l contro l g roup ;obse rve the qua lity of life of t w o g roups o f pati ents w ith RA,anx i e ty(S A S)and depressi on(S D S),Soc i a l Support R a ting(SS R S)sca le ,health i ndex (HAQ ),disease acti v ity sco re (DA S 28)and c li n ica l sy m pto m s ,si gns and laboratory i ndicators o f change .Resu lts 1.Am ong t he 66cases ,YM RA accounted for 71.2%,ERA 28.8%.Co m pared w ith the nor m a l contro l group ,RA pa ti ents w ith t he h i ghest rate o f lung f uncti on abno r m aliti es for FEF 75(66.7%),fo llo w ed by FEF 50,M VV and FEF 25.In ERA g roup the difference ra te of FEF 75w as up to 74.4%,and PEF,M VV abnor m a l rates w ere 73.4%and 57.9%,respecti ve ly pared w ith NC group ,YM RA group and ERA g roup had si gn ifi cantl y lo w er VC ,FE V 1,FVC ,M VV,FEF 25,FEF 50,FEF 75and PEF (P <0.01).Co m pared w it h the YM RA group ,ERA g roup SSRS ,the nu m be r of pa irs o f gr i p streng t h ,ASO,CD 4+CD 25+CD 127-T reg reduc ti on(P <0.05),phy si o l og ical functi ons of i ntegrati on ,so cial function score ,menta l f uncti on sco re ,hea lt h ,know ledge integ rati on,qua lity o f life tota l sco re,S A S,SDS,HAQ,j o i n t s w e lli ng,j o int tenderness,Ch i nese m ed ici ne symptom t o ta l sco re, serum iron,x chest X ray g rade w as sign ifi cantl y higher(P<0.05o r P<0.01).3.Spear m an correlati on ana l ys i s show ed that,ERA group o f pa ti ents w it h pu l m onary f uncti on para m eters o f FEV1and mo rn i ng stiff ness w ere positi ve l yco rre l a ted,FEF25and j o i nt tenderness were positively co rre l a ted(P<0.05).VC,FVC and15m w alki ng ti m e w as nega ti ve l y correlated,FEV1,PEF and joint tenderness a negati ve correlation,MVV w i th the DA S 28w as negatively correlated,FEF50and jo i nt tenderness,15m w al k i ng ti m e w as negati ve l y correlated,FEF75and co m ple m ent C3was negati ve l y co rre l a ted(P<0.05o r P<0.01).Conc l u sion The l ung f unc tion decreased si gn ifican tly i n patients w ith rheuma t o id art hr iti s w ith age increasi ng,and presen ted the se ri ous i n j ury of s m a ll a i rway f unc ti on and dy sfunction as sociated w ith m i xed ventilation(restr icti ve and obstruc ti ve ven til a tory dysf uncti on).[K ey words] A rt hr iti s,R heu m ato i d;Pu l m onary ventil a tion;V ital capac ity;R isk factors类风湿关节炎(RA)是以慢性、进展性滑膜炎为主要病理改变的多系统受累的自身免疫性疾病,全球范围内的发病率约为0.5%,我国的发病率约为0.3%,有较高的致残率和死亡率。