Study On The Correlation Between Coagulation And Fibrinolysis Indexes And Connective Tissue Disease Associated With Interstitial Lung Disease From The Perspective Of "Stasis Blocking Lung Collaterals"

Objective: By observing the characteristics of TCM syndromes and clinical indicators of CTD-ILD(Interstitial lung disease associated with connective tissue disease),the characteristics of CTD-ILD disease and coagulation-fibrinolysis-related indicators(INR,PT,PT A,APTT,TT,FIB,DD,PLT),explore the pathogenesis and risk factors of CTD-ILD in Chinese medicine,and look for effective indicators to detect the early secondary CTD-ILD in order to guide clinical practice.Methods: A total of 489 inpatients in the Depart ment of Pulmonology and Department of Rheumatology and Immunology of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from November 2019 to November 2020 were selected.34 CTD patients and 52 CTD-ILD patients were screened out through inclusion and exclusion criteria.To analyze the statistical differences between the two groups of CTD and CTD-ILD in age,gender,coagulation and fibrinolysis indexes,inflammatory indexes,serum tumor marker levels and positive rates.The inflamma tory indexes and serum tumor marker levels of the two groups were analyzed.Correlation analysis with coagulation and fibrinolysis indexes were carried out;at the same time,the statistical differences of various indexes in CTD-ILD various TCM syndrome types;the evaluation of the risk factors of ILD secondary to CTD and the diagnostic value of coagulation and fibrinolysis indexes,and obtained in conclusion.Results:1.General information: CTD and CTD-ILD are statistically different in gender and age(P<0.05).Compared with CTD-ILD,CTD is more common in women;the average age of onset of patients in the CTD group is 56.68±10.55,the average age of patients in the CTDILD group is 65.40±7.81,and the age of onset of the CTD-ILD group is significantly higher than that of the CTD group;2.Laboratory indicators: CTD and CTD-ILD have significant differences in coagulation and fibrinolysis index levels and positive rates(P<0.05).Compared with CTD group,CTD-ILD is more prone to DD and FIB The index level increased and the PT level decreased,and the positive rate of DD and FIB in the CTD-ILD group was significantly higher than that in the CTD group,the difference was statistically significant(P<0.05),and the index levels of INR,PTA,APTT,and PLT were n ot significant The statistical difference(P>0.05),the higher positive rate of DD in the CTD-ILD group may be related to the age factor;the WBC and CRP index levels and the positive rate in the CTD-ILD group were significantly higher than those in the CT D group,and the difference was significant Sexual significance(P < 0.05).There was no significant statistical difference in ESR and neutrophil percentage(P > 0.05);the levels of CEA,CA724 and CA199 in the CTD-ILD group were significantly higher than those in the CTD group,with very significant statistics There was no significant difference in AFP and Fe DB(P>0.05).The positive rate of CEA and CA199 in CTD-ILD group was significantly higher than that in CTD group,and the difference was statistically significant(P<0.05).3.Risk assessment: gender,age,WBC,CRP,PT,FIB,DD,CA199 are possible risk factors for CTD secondary to interstitial pneumonia,and age and D-dimer are independent risk factors for CTD secondary to ILD.The area under the curve of PT,FIB,D-D and PLT are 0.645,0.622,0.690,0.624,respectively,which has low diagnostic value for CTD-ILD diagnosis.4.Correlation analysis of TCM syndrome types: The CTD-ILD group has the largest number of patients with phlegm stasis obstructing the lung syndrome among the five syndrome types,followed by phlegm-heat stagnation syndrome.Among them,there is no difference in the distribution of male and female syndromes in medical syndromes;the levels of FIB and DD in CTD-ILD patients have very significant statistical differences in the five syndromes(P<0.01),and there is a difference between the syn drome of phlegm and blood stasis obstructing the lung and the syndrome of deficiency of the lung and spleen There were significant statistical differences in FIB and DD index levels(P<0.05).There were significant statistical differences in FIB index levels between phlegm stasis obstructing the lung syndrome and phlegm-heat stagnation syndrome,yin deficiency and lung dryness syndrome respectively(P< 0.05).There was a significant statistical difference in CEA levels between the various syndrome types(P< 0.05).There was no index level of PT,PLT,WBC,neutrophil percentage,CRP,ESR,CA724,and CA199 among patients with various syndrome types.Significant statistical difference(P>0.05).Conclusion:1.Possible risk factors for CTD secondary to interstit ial pneumonia: gender,age,WBC,CRP,PT,FIB,D-D,CA199,among which age and D-dimer are independent risk factors for CTD secondary to ILD.2.The increase of FIB and D-D levels in CTD-ILD patients may be related to the secondary interstitial pneumonia i n CTD,FIB and D-D index levels are affected by the positive correlation of WBC and CRP.3.FIB and D-D as risk assessment indicators have certain significance for the early diagnosis of CTD-ILD.4.The incidence of CTD-ILD is more common in the syndrome o f phlegm stasis obstructing the lung,followed by the syndrome of phlegm-heat accumulating lung.It can be seen that blood stasis,phlegm turbidity,and heat evil are important pathological factors for CTD secondary interstitial pneumonia.