Clinical Study Of Interstitial Pneumonia Associated With Connective Tissue Disease

[Background] CTD-IP is an important complication of CTD, which is also a cause of ⅡPs. CTD-IP plays a pivotal role in the CTD treatment.[Objectives] Investigate clinical types of the CTD-IP patients, lung function, imaging, treatment and outcomes to improve clinical understanding.[Methods] Retrospectively analyze the medical records of patients in our hospital during2011.1.1-2012.1.1, whose primary diseases are one kind of the CTDs, removal of repeated hospitalization and other reasons leading to the IP, including general information, primary disease types, laboratory findings, pulmonary function results, HRCT findings, medication and complications.[Result] Among the group of patients with a total of39cases, the average age of the hospitalized patients was51.5±14.6years, male:female=7:32. Major connective tissue disease types are as follows:PM7cases (17.9%), DM5cases (12.8%), SLE8cases (20.5%), ankylosing spondylitis (AS)1case (2.5%), SSc7cases (17.9%), pSS4cases (10.3%), RA8cases (20.5%), undifferentiated connective tissue disease (UCTD)2cases (5.1%), MCTD2cases (5.1%), systemic vasculitis1case (2.5%) The main clinical manifestations:Rash in16cases (41.0%), shortness of breath10cases (25.6%), hypoxemia by blood gas analysis2cases (5.1%), fatigue17cases (43.6%), arthralgia26cases (66.7%). Extrapulmonary involvement in16cases (41.0%),6cases of osteoporosis (15.4%), two cases of thyroid disease (5.1%). Six cases of patients with Raynaud’s phenomenon (15.4%). HRCT findings prompted the31patients (79.5%) whose lesions mainly located in the lower lobe,17cases (43.6%) patients with lesions in the subpleural,21cases (53.8%) with patch-shadow like lesions, mediastinal lymph nodes23cases (59.0%), only five cases of patients showed the shadow of the frosted glass, fiber cord in17cases (43.6%), nine cases (23.1%) patients with bronchiectasis, grid-like shadow in22cases (56.4%).27cases (69.2%) of all39cases accepted pulmonary function tests. Average of FVC%predicted value (78.6%±14.8%), average of FEV1%predicted value (83.7%±16.0%), average of FEV1/FVC (88.6%±7.4%). Average value of DLCO%is expected to (55.0%±19.5%), the above four lung function and disease activity were not correlated (P>0.05).32patients of all39cases accepted cardiac ultrasound examination,5cases (15.6%) prompted reduced left ventricular diastolic function,13(40.6%) patients with valvular disease or valvular reflux at3cases (9.4%), there is less to the middle amount of pericardial effusion.6cases (18.8%) suffered the PAH. Assessment of patients’ disease activity,29cases (74.4%) for disease activity.23cases (59.0%) were given verdict, sufficient quantities of glucocorticoid after admission, dose of glucocorticoid and primary disease activity were not correlated(P<0.05).27cases (69.2%) were treated with immunosuppressive agents, cyclophosphamide (CTX) in17patients (43.6%), Tripterygium5cases (12.8%), MMF (2.6%), leflunomide(2.6%). The average cost of hospitalization was (11903.1±10998.5), hospital costs had a significant correlation with disease activity(P<0.05).[Conclusion] Onset of the CTD-IP were young female patients with mainly the incidence of people with common CTD incidence crowd. It is necessary to recognize the importance to CTD-IP patients of HRCT and pulmonary function tests. The CTD-IP imaging features are commonly symmetric grid shadows in the lower lobe, with fiber cords leading to bronchiectasis. HRCT performed no correlation with the primary CTD activity. CTD-IP patients often have a restrictive ctivity r defect and diffusing capacity of the obstacles, FVC%predicted value, FEV1%predicted value, FEV1%FVC, and DLCO%predicted value has nothing to do with the CTD disease activity, we need to pay special attention to interstitial pneumonia associated with myositis and systemic sclerosis. The most common complication of hospitalized patients of CTD-IP is pulmonary infection, however, pulmonary infection can be ignored in the assessment of CTD activities. The use of glucocorticoids and immunosuppressive agents for the CTD-IP is the mainstream treatment, the dose of glucocorticoid is related to activity of the primary disease. A serious image manifestations or severe restrictive ctivity r defect and diffuse dysfunction, regardless of their primary disease ctivity, still prompts sufficient quantities of glucocorticoid to control the CTD-IP, and timely use of immunosuppressive agents.