Interstitial Lung Disease Complicated By Connective Tissue Disease (Clinical Study Report Of 597 Cases)

ObjectivesInterstitial Lung disease complicated by Connective Tissue Disease (CTD-ILD)has high incidence and fatality. It is the main reason of the poor prognosis. But because it has not special symptom sand signs when one person got the disease and has not enough knowledge about it ,many CTD-ILD patients were missed diagnosed, He has stayed the sever stage of the disease when one person has typical symptoms and signs. The purpose of this study is to recognize the Interstitial Lung disease complicated by Connective Tissue Disease (CTD-ILD),with the aim of improving the understanding ,It is will be helpful for the early detection ,early diagnosis ,early treatment .Furthermore, it will be improve the prognosis and extend the survival time.Methods597 cases of hospitalized patients who has a clear diagnosis of connective tissue disease [including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis(SSc), Polymyositis/ dermatomyositis (PM/DM), primary Sjogren's syndrome (pSS)]in China-Japan Friendship Hospital, Jilin University from January 1, 2008 to December 31,2009 carried out a retrospective clinical analysis with software application SPSS17.0,T test with measurement data, count data using X2 test, when P <0.05,It has statistically significant.ResultsIn the 597 cases of hospitalized patients suffering from interstitial lung disease (ILD) of 87 patients, the total incidence rate was 14.6%, of which the incidence of various types of CTD for: SLE8%, RA 13.3%, SSC 37.5%, PM / DM29.6%, pSS13.8%. Clinical manifestations: In all connective tissue disease due to interstitial lung damage, respiratory system mainly as cough (36.7%), shortness of breath (32.2%); general expression for the joint pain (50%), fever (47.1%). In all of the CTD-ILD, the high-resolution CT mainly for the grid-like (34.5%), ground glass (32.2%) and pleural thickening (25.3%); blood gas manifestations were hypoxemia (20.6 %), and 1 respiratory failure (19.5%); respiratory manifestations were restrictive ventilatory dysfunction (27.6%), diffuse dysfunction (11.5%) and small airway impairment (12.6%).Clinical manifestations and laboratory comparison whether the various types of immune system diseases with interstitial lung disease : RA-ILD patients with and without rheumatoid factor positive RA patients with interstitial lung disease Compared, P <0.05, both with statistical significance. And RA-ILD patients with IgA (mean 3.59±1.31IU/ml) with and without interstitial lung disease in RA patients with IgA (mean 2.53±0.86 IU / ml) compared, P <0.05, difference statistically significance, significantly higher than RA patients with interstitial lung disease group. SLE-ILD patients with LDH (mean 431.11±332.3U / L) and IgG (mean 19.86±5.18IU/ml) with and without interstitial lung disease in SLE patients with LDH (mean 292.29±209.65U / L) and IgG (mean 15.75±7.49 IU / ml) compared, P <0.05, significant difference was statistically significant, SLE-ILD patients with LDH and IgG than those without interstitial lung disease in SLE patients with LDH and IgG; PM / DM-ILD patients showed myalgia, CK (average 1578.53±2143.64 U / L) and erythrocyte sedimentation rate increased with high interstitial lung disease in non-PM / DM patients compared, P <0.05, difference statistically significant, PM / DM-ILD manifested as muscle pain and in patients with elevated ESR were higher than those without interstitial lung disease in PM / DM patients; pSS merger between lung disease presents with fever and without interstitial lung disease in pSS comparison, P <0.05, significant difference was statistically significant, pSS merger between lung disease than those without fever pSS patients with interstitial lung disease. Treatment: corticosteroids combined with high doses of N-acetyl cysteine and the single treatment with corticosteroids compared with statistical significance. Short course of corticosteroids for the CTD-ILD patients is better. DiscussionsThe experiments show that in all immune system diseases, SSC (incidence rate 37.5%) most likely to cause interstitial lung disease, followed by the PM / DM (incidence rate 29.6%), CTD-ILD onset in order to cough , shortness of breath as the main respiratory symptoms, systemic manifestations as joint pain and fever. High-resolution CT mainly for the grid-like, ground glass changes and pleural thickening; blood gas analysis showed hypoxemia and a major respiratory failure; respiratory function mainly as restrictive ventilatory dysfunction, followed by the diffusing capacity reduction and stingy Road impaired. Therefore, the disease has been diagnosed with the immune system of patients whether patients should pay attention to the occurrence of interstitial lung disease, early advocate for breast-related inspections .In the RA-ILD patients and IgA rheumatoid factor positive and non-RA pat -ients with interstitial lung diseases was statistically significant compared to two, significantly higher than RA patients with interstitial lung diseases group. In RA patients, and IgA rheumatoid factor positive reflect the severity of the situation, can be seen, the RA patients with more severe disease in patients with higher risk of interstitial lung disease, while in the process of diagnosis of RA found inrheum -atoid factor titers, if more high, IgA higher the RA should be alert to the existen- ce of concomitant ILD; SLE-ILD patients with and without LDH and IgG in SLE patients with interstitial lung disease, the LDH and IgG, the difference was signif -ycant statistically significant, SLE- ILD in patients with LDH and IgG than thos- e without interstitial lung disease in patients with SLE LDH and IgG, in patients with SLE complicated with ILD, because of inflammation and release more LDH into the serum IgG and IgG so that LDH increased already diagnosis of SLE is not lear whether patients with interstitial lung disease, not with the line of high -resolution CT, LDH and IgG blood tests can aid diagnosis. PM / DM-ILD pati ents showed muscle pain, fever and ante-Jo-1 positive interstitial lung disease wit -h no PM / DM patients compared the difference was significant, and PM/DM-IL D patients showed muscle pain, fever and anti-Jo-1 positive than those without in -terstitial lung disease, PM / DM patients, accompanied by myalgia, fever and ant i-Jo-1 positive PM / DM patients with a high degree of vigilance should be possi -ble with interstitial lung disease; pSS merger between the type lung disease are fever and non-interstitial lung disease compared with pSS was significant differ- enttce statistically significant, pSS merger between lung disease than those witho -ut fever pSS patients with interstitial lung disease, research shows that, SSA-pos itive pSS patients with fever, rash, high incidence of ILD. PSS patients in this stu -dy, fever in the ILD group and the non-ILD group differences, there is some stat -istical significance, and literature are similar. But the rash and the SSA-positive patients without ILD and ILD group had no difference, no statistical significance, with the reported discrepancies may be related to the previous corticosteroids,im munosuppressive agents, samples and test a small amount related to the different.In the treatment, glutathione is involved in cellular oxidation - reduction reaction of the important material, N-acetyl cysteine (NAC) as a precursor of glutathione, to increase the level of ILD in patients with lung glutathione and play a role in anti-oxidation. By the study implies that large doses of N-acetyl cysteine may retard the progress of interstitial lung disease and improve clinical symptoms in order to improve conditions, and treatment of glucocorticoid response depends on the progress of maturity of fibrosis, used alveolar or interstitial lung in inflammatory exudative, proliferative changes in the ILD and so on, has been formed on the lung fibrosis or other non-exudative changes associated with inflammatory diseases, the effect little performance as possible side effects to hormone-based clinical course. Experimental results were obtained by the application of a short course of hormone can improve the ILD patients, patients on the longer course of little value, but also can cause adverse reactions, such as disseminated tuberculosis, liver dysfunction, infections, when applied It should be noted.In summary, the various types of immune system diseases with the above symptoms occur, and laboratory tests to a high degree of vigilance against the possible emergence of interstitial lung disease, so that early diagnosis, early treatment and reduce mortality and prolong survival time.