| Objective: Pulmonary interstitial disease(ILD)is the most common and serious pulmonary disease of Sjogren ’s syndrome involving the respiratory system.By collecting the cases of ILD secondary to Sjogren’ s syndrome in Shandong Provincial Hospital of Traditional Chinese Medicine,the clinical information of traditional Chinese and western medicine was analyzed,and the disease characteristics,TCM syndrome types and risk factors were explored to provide a theoretical basis for the early screening and diagnosis of the disease.Methods: According to the inclusion and exclusion criteria,the clinical data of 169 patients with newly diagnosed primary Sjogren ’s syndrome and primary Sjogren’ s syndrome secondary pulmonary interstitial disease during hospitalization in the Department of Rheumatology and Immunology,Shandong Provincial Hospital of Traditional Chinese Medicine from January 2019 to December 2022 were collected.The collected and collated relevant data were entered into Excel to establish a database.The general data,laboratory tests,clinical manifestations and TCM syndrome differentiation were analyzed by statistical methods.Results:1.In the general situationA total of 168 patients with Sjogren ’s syndrome were included,including 23 males(13.6%)and 146 females(86.4%),including 101 patients with Sjogren’ s syndrome without interstitial lung disease,17 males(16.8%)and 84 females(83.2%),with an average age of 45.72 ± 1.40 and an average disease duration of 56.92 ± 5.07.There were68 patients with Sjogren ’s syndrome complicated with pulmonary interstitial disease,among whom 6(8.8%)were males and 62(91.2%)were females,with mean age of 58.18± 1.261 and mean disease course of 98.90 ± 6.54.Smoking was higher in the pSS-ILD group.2.Clinical manifestationsThrough statistical analysis,it was found that the incidence of Raynaud ’s,rampant teeth,oral ulcers,digestive system symptoms,and pulmonary symptoms in pSS-ILD patients was significantly higher than that in pSS patients.The sleep quality of pSS-ILD patients was significantly decreased,P < 0.01,which was statistically significant.There was no significant statistical difference in the remaining symptoms.decreased significantly(P < 0.01),which was statistically significant.There was no significant difference in other symptoms.3.Laboratory testsLactate dehydrogenase,erythrocyte sedimentation rate,C-reactive protein,ferritin,and D-dimer parameters in the general laboratory tests of patients in the pSS-ILD group were higher than those of patients in the pSS group,and the differences were statistically significant.Other laboratory parameters were not significantly different.Among the immunological parameters,the positive rates of anti-SSA antibody,anti-SSB antibody and anti-Ro52 antibody in pSS-ILD group were higher than those in pSS group.IgG,rheumatoid factor,C3 and C4 were statistically significant between the two groups(P <0.01).4.Lung high-resolution CTThe imaging findings of patients with pSS from high to low were ground-glass opacities in 17 patients(16.8%),cord-like opacities in 17 patients(16.8%),patchy opacities in 15 patients(14.9%),grid opacities in 12 patients(11.9%),bronchiectasis in 10patients(14.9%),nodular opacities in 9 patients(8.9%),bullae in 9 patients(8.9%),cystic opacities in 8 patients(7.9%),honeycombing in 7 patients(6.9%),and pulmonary hypertension in 4 patients(4%).The imaging findings of pSS-ILD patients from high to low were patchy shadows in 28 patients(41.2%),ground-glass opacities in 23 patients(33.8%),cord-like shadows in 22 patients(32.4%),grid shadows in 18 patients(26.5%),nodular shadows in 18 patients(26.5%),bronchiectasis in 15 patients(22.1%),cystic shadows in 14 patients(20.6%),honeycombing in 13 patients(19.1%),bullae in 12patients(17.6%),and pulmonary hypertension in 6 patients(8.8%).5.TCM symptom distributionIn the pSS group,53 cases(52.5%)had deficiency of both qi and yin,14 cases(13.9%)had dampness-heat blocking collateral syndrome,13 cases(12.9%)had deficiency of liver-kidney yin,13 cases(12.9%)had obstruction of qi and blood stasis,and 8 cases(7.9%)had dryness evil offending lung syndrome from high to low;42 cases(%)had cracks,29 cases(%)had Shaojin,13 cases had fat\tooth marks,12 cases had thin\tooth marks,12 cases had normal tongue color distribution from high to low to dark red,30 cases had dark\blood stasis\purple,17 cases had pale white,12 cases had light red,48 cases had tongue coating from high to low,27 cases had exfoliation,15 cases had yellow greasy,6 cases had thin yellow,3 cases had thin white pulse.In the pSS-ILD group,35 patients(51.5%)had TCM syndrome types from high to low as yin deficiency and blood stasis,lung loss and descending syndrome,19 patients(11.2%)had both qi and yin injury and lung loss and descending syndrome,5 patients(7.4%)had liver-fire offending lung and lung loss and descending syndrome,5 patients(7.4%)had heat toxin accumulation lung and lung loss and descending syndrome,and 4 patients(5.9%)had phlegm-dampness accumulation lung and lung loss and descending syndrome;the tongue distribution from high to low was cracks in 26 patients,thin in 24 patients,Shaojin in 9 patients,normal in 5patients,fat in 4 patients,and the tongue color distribution from high to low was dark\blood stasis\purple in 29 patients,dark red in 24 patients,light red in 8 patients,and pale in 7 patients;6.Analysis of risk factors of pulmonary interstitial disease secondary to Sjogren ’s syndromeFirst,univariate logistic regression was used to analyze the general epidemiology and laboratory parameters of the two groups of patients one by one.Then binary logistic regression was used to analyze the indexes with P value less than 0.01,and it was concluded that age,course of disease,erythrocyte sedimentation rate,and lactate dehydrogenase were independent risk factors for pulmonary interstitial disease secondary to Sjogren’s syndrome.ROC curve analysis was performed for age,disease duration,erythrocyte sedimentation rate,and lactate dehydrogenase,and the ROC curve areas for predicting pulmonary interstitial disease secondary to Sjogren’s syndrome were 0.755,0.784,0.677,and 0.859,respectively.Conclusion:In this study,the incidence of pSS-ILD was up to 40.2% by statistical analysis.The age,course of disease and smoking number of pSS-ILD patients were significantly higher than those of pSS patients.2.Patients with pSS-ILD have faster erythrocyte sedimentation rate and higher Creactive protein,ferritin,D-dimer,and lactate dehydrogenase parameters.3.pSS-ILD patients are more likely to have Raynaud ’s,rampant teeth,digestive symptoms,and respiratory symptoms.4.In this analysis,it was found that the imaging findings of pSS-ILD patients were mostly patchy shadows and ground-glass opacities.5.The most common TCM syndromes of pSS-ILD are yin deficiency and blood stasis,lung loss and descending syndrome;the most common tongue images are fissured tongue,thin tongue,dark\blood stasis\purple,deep red,exfoliation,and yellow greasy;and the most common pulse conditions are the number of pulse strings and the number of pulse strings.6.Regression analysis showed that age,course of disease,erythrocyte sedimentation rate and lactate dehydrogenase were independent risk factors of pulmonary interstitial disease secondary to Sjogren ’s syndrome,and had a certain diagnostic effect on pulmonary interstitial disease secondary to Sjogren’ s syndrome. |
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