类风湿关节炎相关间质性肺病的研究进展-现代医学

类风湿关节炎相关间质性肺病的研究进展

单位：东部战区总医院(原南京军区南京总医院) 中医结合科, 江苏南京 210002

分类号：R392.1

出版年·卷·期（页码）：2020·48·第八期（1093-1099）

摘要：

间质性肺病（interstitial lung disease，ILD）是类风湿关节炎（rheumatoid arthritis，RA）患者常见的并发症之一，且与RA患者发病率和死亡率增加有关。大约1/3的患者有不同程度的功能障碍的亚临床症状。尽管RA-ILD的风险已明确（如高龄、男性、吸烟史、血清类风湿因子和抗环瓜氨酸肽抗体阳性），但对于疾病的评估、治疗和监测的研究较少。RA-ILD患者还存在感染和药物毒性的高风险，与合并症一起使治疗更为复杂。RA-ILD具有不同的组织病理学类型，不同的临床表型、自然病程和预后。RA-ILD亚型普通型间质性肺炎（usual interstitial pneumonia，UIP）与特发性肺纤维化（idiopathic pulmonary fibrosis，IPF）具有许多相同的临床及组织病理学特征，表明存在相同的发病机制和治疗靶点。我们对RA-ILD的认识仍存在很大的差距。我们对RA-UIP和其他RA-ILD亚型发病机制的阐明，对研发更有效、更安全的药物很有帮助。

Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. In addition, approximately one-third of patients have subclinical disease with varying degrees of functional impairment. While risk factors for RA-ILD are well established (older age, male gender, ever smoking history and seropositivity to rheumatoid factor and anti-cyclic citrullinated peptide antibodies) little is known about optimal disease assessment, treatment and monitoring, particularly in patients with progressive disease. Patients with RA-ILD are also at high risk of infection and drug toxicity, which, along with comorbidities, complicate further treatment decision making. There are distinct histopathologic patterns of RA-ILD with different clinical phenotypes, natural history and prognosis. Of these, the usual interstitial pneumonia (UIP) subtype of RA-ILD shares a number of clinical and histopathologic features with idiopathic pulmonary fibrosis (IPF), the most common and severe of the idiopathic interstitial pneumonias, suggesting the existence of common mechanistic pathways and possibly therapeutic targets. There still are substantial gaps in our knowledge of RA-ILD. Our elucidation of the pathogenesis of RA-UIP and other RA-ILD subtypes is helpful in developing more effective and safer drugs.

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