Analysis On Clinical Characteristics Of402Patients With Interstitial Lung Disease

BackgroundInterstitial lung disease (interstitial lung diseases, ILD) is a set of involving thepulmonary interstitial and alveolar bronchiole and pulmonary diffuse disease,which isoften called diffuse material lung disease (diffuse parenchymal lung diseases, DPLD).Research shows that smoking, occupational dust or environmental exposure, infection(virus),gastro-esophageal reflux and the harm of drugs are high risk factors ofinterstitial lung disease. At present the pathogenesis of interstitial lung disease is notentirely clear, but with the progress of cell biology and molecular biology technology,more and more found cytokine mediated cells and cellular interactions on the decisionof alveolar inflammation and fibrosis results play an important role. Different levelsof inflammatory injury and repair process can lead to the formation of pulmonaryfibrosis.These inflammatory cells,alveolar epithelial cells,immune cells andfibroblasts and its medium and cytokine secretion,are involved in the formationprocess of pulmonary fibrosis.In addition,IL-8,tumor necrosis factor alpha(TNF-alpha) and transforming growth factor beta (TGF-beta) are involved in the lungtissue injury and repair process. ATS/European respiratory society consensus will besmoking related interstitial lung disease is divided into a subtype of idiopathicinterstitial pneumonia, but recent studies have found that smoking related interstitial pneumonia is not of unknown cause, and smoking is the main pathogenic factors. Butthe role of smoking in pulmonary fibrosis research, lung injury caused by tobacco,acceleration of pulmonary fibrosis could be the cause.Interstitial lung disease is not an independent disease.It includes more than200diseases.Although each has different pathogen.But they are the same to the clinicalcharacteristics.ATS (ATS)/European respiratory society (ERS) through consensus thespecification name of disease, diagnosis have been standardized, and emphasized theimportance of clinical image-pathological combining, but because of interstitial lungdisease continues to know and research stage, its diagnosis and treatment of standardupdates will continue, this will require a clinical researchers pay close attention to,timely correct diagnosis and treatment of disease.Some of interstitial lung diseases（CTD）are given priority to with inflammatorychange, such as connective tissue disease related interstitial lung disease（sCTD-ILD）.Connective tissue disease is a major violation of systemic autoimmune diseases,connective tissue and blood vessels in lung and pleura are rich in collagen, bloodvessels and other connective tissue, as a result, the respiratory system is one of themost common organ involvement connective tissue diseases, even is the startingperformance with respiratory symptoms, and connective tissue diseases onceinvolving the respiratory system, concurrent interstitial lung disease, survival ratesignificantly reduced.CTD-ILD is a multiple system disease, early the signs andsymptoms of lack of specificity, lead to early diagnosis is difficult, missed diagnosisand misdiagnosis, once confirmed the late may.If can remove the cause or givesymptomatic treatment at early stage, the inflammatory change can be reversed, orinflammation, cause lung structure destruction, fibrous tissue hyperplasia, eventuallyforming irreversible pulmonary fibrosis or honeycombing, seriously affect the lungfunction, and even can lead to respiratory failure or death. Multiple, high incidenceand high mortality rate of the disease gradually to the attention of the people, studythe classification of interstitial lung disease, clinical characteristics and treatment ofdisease prognosis, etc, have great significance.Objective This study aims to investigate the clinical and HRCT features of connectivetissue diseases and interstitial lung disease (CTD-ILD) and idiopathic pulmonaryfibrosi（sIPF）,in order to improve the diagnosis and therapy level of the CTD-ILD. Soas to achieve early discovery,early diagnosis and early treatment, actively improvethe symptoms and prognosis of patients.MethodsCollect the data of402patients with ILD who were hospitalized in the firstaffiliated hospital of Zhengzhou University from2011to2013. Retrospectivelyanalysis the clinical and CT features of the352cases of CTD-ILD and50cases ofIPF. Will connective tissue disease related interstitial lung disease according tovarious types of connective tissue disease is divided into7groups compared betweengroups, application SPSS12.0statistical software for data analysis,includingcorrelation with connective tissue disease in patients with interstitial lung disease ofgender, age, disease types, distribution between urban and rural areas, smoking,andclinical symptoms and imaging characteristics of descriptive analysis andcomparative analysis, correlation analysis between groups of connective tissuedisease clinical symptoms of interstitial lung disease, HRCT manifestations and lungfunction.Results1.Women are more than men with CTD-ILD;.Men are more than women withIPF;2.The clinical features of CTD-ILD mainly are respiratory symptoms(cough,expectaration,chest distress) and systemic symptoms (fever,arthralgia,Skininvolvement,hypodynamic).Systemic symptoms are more than respiratory symptoms.The clinical features of IPF mainly are respiratory symptoms,and acropachia is alsothe common sign.3.The HRCT of CTD-ILD are mainly imaging ground glass shadow,grid, pleuralthickening and pleural effusion. The HRCT of IPF mainly are honeycomb lung.Thechanges are mainly in low lung zones with both CTD-ILD and IPF.There aresymmetry in both lungs. 4.The258cases (73.2%) of CTD-ILD lung function are restrictive ventilatordysfunction and dispersion dysfunction.35cases (9.9%) of CTD-ILD lung functionare hybrid ventilator dysfunction. The42cases (98%) of IPF lung function arerestrictive ventilator dysfunction5.The symptoms of patients with CTD-ILD and IPF are relieve when cured byglucocorticoids and anti-fibrosis drug.In addition,there are no difference between twogroups.6.The prognosis of the patients who infected are worse.Additionally, theprogression disease of patients with PM/DM-ILD are fast than those with RA-ILDand pSS-ILD.Conclusion1.Incidence have differences between men and women in CTD-ILD and IPF.Inpart of CTD-ILD,respiratory system symptoms are earlier than systemic symptom,and can be independent.2.The patients who smoking are easier be attacked by CTD-ILD and IPF.3.We should take CTD-ILD into consideration when HRCT changes areinvolved the pleural and glass shadow.In the early stages is sensitivity toglucocorticoid treatment.When occurred to honeycomb lung,IPF may be thediagnosis.It is not obvious when cured by glucocorticoid.4.The lung function mainly are restrictive ventilator dysfunction and dispersiondysfunction in two groups.CTD-ILD should be hybrid ventilator dysfunction.5. HRCT findings are interstitial lung disease,then it should be alert to thepossibility of secondary to CTD.We should monitor the indicators in time.6.In order to prevent from infection, nursing and curing are both impotant for thepatients with ILD.