Clinical Analysis Of Systemic Sclerosis Complicated With Interstitial Lung Disease

BackgroundSystemic sclerosis?systemic sclerosis,SSc?is a relatively rare connective tissue disease characterized by localized or diffuse skin hardening and thickening,accompanied by damage to internal organs such as lung,heart,kidney,digestive tract and so on.there are interstitial lung disease?ILD?in lungs,and ILD are the main causes of death in patients with SSc.The prognosis of SSc-ILD is poor and the mortality rate is high.Some biomarkers may be risk factors for the development of ILD and SSc-ILD in SSc,but the results are different.There is no unified and effective regimen for the treatment of SSc-ILD,hormones and Immune inhibitors are the first choice,new targeted drugs still need to be further explored.At present,there is a lack of systematic diagnosis and treatment of the disease,and there are no obvious clinical symptoms in the initial stage of patients with ILD.Most of the patients can not regularly monitor the imaging and pulmonary function examination,resulting in interstitial changes in the lungs when there are dyspnea and other symptoms.It affects the quality of life and the long-term prognosis of the patients.PurposeThrough statistical analysis of the clinical data of SSc group and SSc-ILD group,this paper further studied the significance of serological markers in SSc patients with ILD,as well as the significance of HRCT?high resolution,CT?and pulmonary function in the diagnosis and treatment of SSc-ILD.Furthermore,it can improve clinicians'understanding of SSc and SSc-ILD disease,promote early diagnosis and treatment of SSc-ILD patients,guide clinicians to manage and follow up such patients,and improve the quality of life and prognosis.MethodsThis study was a retrospective study.according to the inclusion and exclusion criteria of the subjects,the clinical data of 80 patients with systemic sclerosis admitted to our hospital from January 2016 to May 2018 were collected.They were divided into systemic sclerosis group?SSc?and systemic sclerosis combined with interstitial lung disease group?SSc-ILD?.Sex,age,clinical manifestations,serological autoantibodies,complement C3,complement C4,ESR,CRP,1,25-?OH?₂VitD₃,KL-6 and lung function were collected.Clinical data such as energy,chest CT findings,treatment drug selection and so on.SPSS24.0 statistical software package was used for statistical analysis of the collected data.Results1.A total of 80 subjects were studied,most of them were women,accounting for 66 cases?82.5%?.There was no significant difference in sex ratio between SSc group and SSc-ILD group?P>0.05?.The mean age was 54.36±11.83,and the mean age was 54.36±11.83 between the two groups.There was no significant difference in age?P>0.05?.2.no respiratory symptoms were found in 44.44%of the patients in SSc-ILD group.the most common clinical manifestations were chest tightness,shortness of breath?26.89%?and cough?15.87%?.There was no significant difference in the proportion of localized and diffuse SSc between the two groups?P?0.133?.There was no significant difference between localized and diffuse SSc with ILD and without ILD?P?0.133?.3.compared with SSc group,the positive rate of anti-Scl-70 antibody in SSc-ILD group was higher?P?0.04?,and the positive rate of anti-centromere antibody in SSc-ILD group was lower?P?0.01?.KL-6 was significantly increased in SSC-ILD group.There was significant difference between the two groups?P?0.002?,but there was no significant difference in other autoantibodies,ESR,CRP,complement C3,complement C4,1,25-?OH?₂VitD₃ between the two groups.4.Among the HRCT findings,8 cases?16%?were UIP and 42 cases?84%?were non-UIP.According to the limit of 20%of the lung area,the lesions were divided into two groups:more than 20%and less than 20%,of which more than 20% accounted for 22%and less than 20%accounted for 78%.There was no significant difference in sex,age,autoantibody,FVC and FEV1/FVC between the two groups,but there was significant difference in KL-6 between the two groups.And in chest images,mediastinal lymph node enlargement accounted for 20%,axillary lymph node enlargement accounted for 18%.5.FVC and FEV1/FVC decreased more significantly in systemic sclerosis complicated with interstitial lung disease,the difference was statistically significant,but there was no significant difference in DLCO between the two groups.6.The main treatment of SSc-ILD was hormone?46%?,followed by hormone and Immune inhibitors.hormone dose are 5-45mg/d,Immune inhibitors was mainly yclophosphamide and methotrexate.Some patients were treated with N-acetylcysteine?NAC?and pirfenidone.Conclusion:1.Diffuse skin changes,positive anti-Scl-70 antibody,elevated KL-6,decreased VC and FEV1/FVC suggested that SSc patients were more likely to be complicated with ILD,while patients with positive anti-centromere antibody were less likely to be complicated with ILD.The change of DLCO was affected by many factors,and its decrease may not indicate whether ILD was combined.Gender and age differences were not associated with ILD in patients with SSc.2.The area of pulmonary interstitial changes in patients with SSc-ILD was less than20%,and the range of pulmonary interstitial changes was related to the elevation of KL-6,but not to age,sex and autoantibodies.