| Objective: To retrospectively study the clinical characteristics of Sjogren’s syndrome combined with pulmonary interstitial lesions,evaluate the value of each clinical characteristic in the diagnosis and treatment of SS-ILD,and analyze the risk factors of lung involvement;To study the distribution of SS-ILD syndromes in traditional Chinese medicine(TCM)and the relationship between syndromes and clinical features,so as to provide clinical basis for TCM syndrome differentiation and realize the early diagnosis and intervention of SSILD.Methods: According to the inclusion and exclusion criteria,a total of 142 cases of SS patients who visited the Affiliated Hospital of Shandong University of Chinese Medicine from November 2019 to December2021 were collected,including 84 cases of SS and 58 cases of SSILD.Syndrome differentiation was performed according to the diagnostic criteria of traditional Chinese medicine(TCM)syndromes.SPSS25.0 was used for statistical analysis of general information,clinical manifestations,related laboratory indicators,chest HRCT and TCM syndromes of the patients.Result:1.A total of 142 patients with SS were included,with the ratio of male to female being 1: 16.8,the average age of 55.35 12.7years old,the onset age of 50.59 12.6 years old,the course of disease expressed as 3.0(1.0,7.0)years by quartile,and five smokers.2.In SS group,the incidence of local manifestations ranged from high to low as dry mouth and eyes(79.8%)> fatigue and asthenia(51.2%)>rampant dental caries(32.1%)> Reynold’s disease(4.8%);In the SS-ILD group,the incidence of local manifestations ranged from high to low as dry mouth and eyes(77.6%)> fatigue and asthenia(56.9%)> rampant dental caries(36.2%)> Reynold’s syndrome(10.3%);In SS group,the main systemic manifestations involved were joint pain(28.6%),blood system involvement(26.2%),chronic gastritis/reflux esophagitis(26.2%),and skin damage(17.9%).In the SS-ILD group,the main systemic manifestations of involvement were hematological system involvement(24.1%),chronic gastritis/reflux esophagitis(22.4%),joint pain(20.7%),and skin lesions(19%).3.Among the 84 patients in the SS group and 58 cases of SS-ILD,SS-ILD group was more prone to cough and expectoration of respiratory tract manifestations than SS group,and the difference was statistically significant(p < 0.01).No statistical difference was found in gender,course of disease or smoking history between the two groups(p > 0.05).Patients in SS-ILD group were older than SS group and the difference was statistically significant(p < 0.01).Patients in SS-ILD group were older than SS group and the difference was statistically significant(p< 0.05).4.WBC,NE,Ig G,CEA,ferritin and ESR of patients in SS-ILD group were higher than those in SS group(p < 0.05).ESSDAI score of SS-ILD group was higher than that of SS group(p < 0.01).Patients in the SS-ILD group had positive anti-SSA antibodies and lower complement C3 than those in the SS group,and the differences were statistically significant(p < 0.05).There was no significant difference in other indicators between the two groups(p > 0.05).5.Respiratory symptoms in SS combined with ILD group were cough(33cases(31.7%),expectoration(28 cases(26.9%),chest distress(23cases(22.1%),dyspnea(15 cases(14.4%),shortness of breath(4 cases(3.8%),and chest pain(1 case(1.0%).In the ILD-combined group,the HRCT imaging findings of the chest were reticular 31(22.3%),groundglass 27(19.4%),patchy 26(18.7%),nodular 20(14.4%),striated19(13.7%),pleural thickening 7(5.04%),honeycomb 4(2.88%),vesicular3(2.16%),and interlobular septal thickening 2(1.44%).6.Among the 142 patients,38 were of the dryness-pathogen invading the lung syndrome,29 were of the qi and blood stasis syndrome,29 were of the yin deficiency lung syndrome,and 46 were of the qi and yin deficiency syndrome.The incidence of SS combined with ILD in different TCM syndrome types ranged from high to low: dryness-pathogen invading the lung syndrome > qi and blood stasis syndrome > qi and yin deficiency syndrome > yin deficiency lung dryness syndrome,and the differences were statistically significant(p < 0.05).7.In the syndrome of dryness pathogen invading lung,the scores of age,CEA,CRP,and ESSDAI of SS-ILD group were higher than those of SS group,and it was easier for SS group to produce the symptoms of expectoration and joint pain,and the difference was statistically significant(p <0.05).In the syndrome of qi and blood stagnation,the onset age,Ig G,ESR,CRP,and ESSDAI scores of SS-ILD group were higher than those of SS group,and cough and expectoration were more likely to occur than that of SS group,and the differences were statistically significant(p< 0.05).In the syndrome of qi-yin deficiency,the TG and ESSDAI scores of SS-ILD group were higher than those of SS group,and cough was more likely to occur than that of SS group.However,complement C4 was lower than that of SS group,and the differences were statistically significant(p < 0.05).The ESSDAI score of SS-ILD in Yin deficiency and lung dryness syndrome was higher than that of SS group,and SS group was more prone to fatigue,fatigue and skin damage,and the difference was statistically significant(p < 0.05).In the other syndromes,there was no significant difference in clinical features between SS group and SS-ILD group(p > 0.05).Conclusion: 1.SS mostly occurs in middle-aged and elderly women;2.Patients with SS,including elder,elder in onset of disease,cough and expectoration,or SS accompanied by increased WBC,NE,Ig G,CEA,ferritin,and ESR,positive rate of anti-SSA antibody,and decreased complement C3,are more likely to develop interstitial lung disease.3.HRCT of the chest in patients with SS with pulmonary interstitial lesions mainly shows reticulocyte shadow,ground-glass opacity and patchy opacity.4.The syndrome of dryness pathogen invading lung and the syndrome of qi and blood stasis are more likely to be combined with interstitial lung disease,which has a reference role in clinical TCM syndrome differentiation. |
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