不同病因肺间质纤维化与肺痹相关性探讨
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摘要
目的：调查继发于结缔组织病肺间质纤维化和特发性肺间质纤维化的临床症状、中医证候及预后等方面的特点,从而探讨不同病因肺问质纤维化与肺痹的相关性,为肺间质纤维化的中医病名归属和临床诊疗提供思路。
方法：本课题采用回顾性方法,收集114例肺间质纤维化患者的病历资料,按致病原因分为继发于结缔组织病肺间质纤维化(继发组)和特发性肺间质纤维化(特发组)。统计分析两组资料的临床症状、中医证候及预后等方面的特点,并加以比较。
结果：
1.性别和年龄：继发组和特发组发病的性别和年龄段分布差异,卡方检验有统计学意义(P<0.05),继发组以50岁左右的女性多见；特发组以70岁以上男性多见。
2.发病季节：继发组和特发组发病季节无差异(P>0.05),均以秋季发病多见。
3.临床症状：肺系症状中的气短、喘息、憋气、咳嗽、咳痰,特发组出现频率高于继发组(p<0.05)；肢体痹症状中关节疼痛、关节肿胀、皮肤红斑或结节、皮肤发紧变硬及肌肉疼痛无力,继发组出现频率高于特发组(p<0.05)
4.中医证候：肺间质纤维化的病性多为虚实夹杂,证型以气阴两虚夹血瘀型最常见。大部分患者出现不同程度的脏腑亏虚,一般表现为单脏为病或数脏相兼为病,其中以肺虚和肺肾两虚所占比例最多。
5.病情评价：特发组较继发组易出现肺动脉高压,程度较重(p<0.05)；伴随肺动脉高压的加重更容易出现右心室肥大(p<0.01)；特发组出现Vecrol啰音与杵状指的频率较继发组高(p<0.01)；肺功能检查中,特发组TCL、FVC、Dloc较继发组下降明显(p<0.01)
6.预后：特发组相对继发组预后更差,死亡率高(p<0.05)。
结论：
1.继发于结缔组织病肺间质纤维化和特发性肺间质纤维化均可归属于中医肺痹范畴。
2.继发于结缔组织病肺间质纤维化以中年女性多见,肢体痹与肺系症状多同时存在,中医证候多为本虚标实、虚实夹杂。治疗上对肢体痹症状和肺系症状应加以兼顾。
3.特发性肺间质纤维化以老年男性多见,肢体痹症状少见,肺系症状突出,肺功能降低明显,病情程度重,预后不良。治疗应以调整肺肾脏腑功能、改善肺系症状、延长生存期为主。
Objective:From studying the features of clinical manifestations, TCM syndromes and prognosis between idiopathic pulmonary fibrosis (IPF) and interstitial lung disease associated with connective tissue disorder,secondary pulmonary fibrosis(SPF), discuss the dependability among PF of different pathogeny and pulmonary arthralgia to provide ideas for the TCM name and clinical therapia of pulmonary fibrosis disease.
Method:The subject applies the way of reviewing study,and collects 114 cases of PF patients classified into idiopathic group and secondary group by the pathogenesis, statisticsing and analyzing the features of clinical manifestations, TCM syndromes and prognosis of PF, and comparing the difference among them.
Results:
l.Sex and age:At the aspects of sex and age bracket, SPF and IPF have differences by X2 proof-test (P< 0.05). most patients of SPF are women about the age of 50, and most patients of IPF are men older than 70.
2.Season of disease:Comparing the season of disease between SPF and IPF, P> 0.05, there is no differences. In two groups, the onset is usually in the Autumn.
3.Clinical manifestations:more patients of IPF have the symptoms of lung than SPF, such as pant, gasp, suffocation, cough, expectoration (p< 0.05); meanwhile more patients of SPF have the symptoms of body than IPF, such as joint pain, joint swelling, skin erythema or nodules, skin hardens and muscle pain or weakness in tight (p< 0.05).
4.Syndrome:the nature of PF is intermingled deficiency and excess, with Qi and Yin Deficiency inclusion of blood stasis syndromes of the most common syndrome type. Organs in most patients have different degrees of deficiency, and the general performance is a single or a few organs simultaneous deficiency, in which lung deficiency and kidney deficiency have the largest proportion.
5.Evaluation of disease:idiopathic group is prone to suffer from pulmonary hypertension and more severe than secondary group (p< 0.05); with pulmonary hypertension becoming severe, it is more likely to bring about right ventricular hypertrophy (p< 0.005); the patients in idiopathic group have Vecrol rales and clubbed finger more frequently than the secondary group (p< 0.005); In the Pulmonary function testing, TCL, FVC, Dloc of idiopathic group decreased significantly compared with the secondary group.
6.prognosis:diopathic group has relatively worse prognosis and high mortality than secondary group (p< 0.05).
Conclusion:
1.TCM name of SPF and IPF belong to pulmonary arthralgia.
2.Patients of SPF are mostly middle-aged females, with the symptoms of body arthralgia and pulmonary existing at the same time, syndrome of deficiency in origin and excess in superficislity. so the treatment of the body arthralgia symptoms and pulmonary symptoms should be balanced.
3.IPF is more common to older men. They have less body arthralgia symptoms but more pulmonary symptoms, and the lung function decreased significantly, with severe condition and poor prognosis. so the therapy should focus on how to adjust the organs function of lung and kidney, improve the symptom of pulmonary and prolong survival based.
方法：本课题采用回顾性方法,收集114例肺间质纤维化患者的病历资料,按致病原因分为继发于结缔组织病肺间质纤维化(继发组)和特发性肺间质纤维化(特发组)。统计分析两组资料的临床症状、中医证候及预后等方面的特点,并加以比较。
结果：
1.性别和年龄：继发组和特发组发病的性别和年龄段分布差异,卡方检验有统计学意义(P<0.05),继发组以50岁左右的女性多见；特发组以70岁以上男性多见。
2.发病季节：继发组和特发组发病季节无差异(P>0.05),均以秋季发病多见。
3.临床症状：肺系症状中的气短、喘息、憋气、咳嗽、咳痰,特发组出现频率高于继发组(p<0.05)；肢体痹症状中关节疼痛、关节肿胀、皮肤红斑或结节、皮肤发紧变硬及肌肉疼痛无力,继发组出现频率高于特发组(p<0.05)
4.中医证候：肺间质纤维化的病性多为虚实夹杂,证型以气阴两虚夹血瘀型最常见。大部分患者出现不同程度的脏腑亏虚,一般表现为单脏为病或数脏相兼为病,其中以肺虚和肺肾两虚所占比例最多。
5.病情评价：特发组较继发组易出现肺动脉高压,程度较重(p<0.05)；伴随肺动脉高压的加重更容易出现右心室肥大(p<0.01)；特发组出现Vecrol啰音与杵状指的频率较继发组高(p<0.01)；肺功能检查中,特发组TCL、FVC、Dloc较继发组下降明显(p<0.01)
6.预后：特发组相对继发组预后更差,死亡率高(p<0.05)。
结论：
1.继发于结缔组织病肺间质纤维化和特发性肺间质纤维化均可归属于中医肺痹范畴。
2.继发于结缔组织病肺间质纤维化以中年女性多见,肢体痹与肺系症状多同时存在,中医证候多为本虚标实、虚实夹杂。治疗上对肢体痹症状和肺系症状应加以兼顾。
3.特发性肺间质纤维化以老年男性多见,肢体痹症状少见,肺系症状突出,肺功能降低明显,病情程度重,预后不良。治疗应以调整肺肾脏腑功能、改善肺系症状、延长生存期为主。
Objective:From studying the features of clinical manifestations, TCM syndromes and prognosis between idiopathic pulmonary fibrosis (IPF) and interstitial lung disease associated with connective tissue disorder,secondary pulmonary fibrosis(SPF), discuss the dependability among PF of different pathogeny and pulmonary arthralgia to provide ideas for the TCM name and clinical therapia of pulmonary fibrosis disease.
Method:The subject applies the way of reviewing study,and collects 114 cases of PF patients classified into idiopathic group and secondary group by the pathogenesis, statisticsing and analyzing the features of clinical manifestations, TCM syndromes and prognosis of PF, and comparing the difference among them.
Results:
l.Sex and age:At the aspects of sex and age bracket, SPF and IPF have differences by X2 proof-test (P< 0.05). most patients of SPF are women about the age of 50, and most patients of IPF are men older than 70.
2.Season of disease:Comparing the season of disease between SPF and IPF, P> 0.05, there is no differences. In two groups, the onset is usually in the Autumn.
3.Clinical manifestations:more patients of IPF have the symptoms of lung than SPF, such as pant, gasp, suffocation, cough, expectoration (p< 0.05); meanwhile more patients of SPF have the symptoms of body than IPF, such as joint pain, joint swelling, skin erythema or nodules, skin hardens and muscle pain or weakness in tight (p< 0.05).
4.Syndrome:the nature of PF is intermingled deficiency and excess, with Qi and Yin Deficiency inclusion of blood stasis syndromes of the most common syndrome type. Organs in most patients have different degrees of deficiency, and the general performance is a single or a few organs simultaneous deficiency, in which lung deficiency and kidney deficiency have the largest proportion.
5.Evaluation of disease:idiopathic group is prone to suffer from pulmonary hypertension and more severe than secondary group (p< 0.05); with pulmonary hypertension becoming severe, it is more likely to bring about right ventricular hypertrophy (p< 0.005); the patients in idiopathic group have Vecrol rales and clubbed finger more frequently than the secondary group (p< 0.005); In the Pulmonary function testing, TCL, FVC, Dloc of idiopathic group decreased significantly compared with the secondary group.
6.prognosis:diopathic group has relatively worse prognosis and high mortality than secondary group (p< 0.05).
Conclusion:
1.TCM name of SPF and IPF belong to pulmonary arthralgia.
2.Patients of SPF are mostly middle-aged females, with the symptoms of body arthralgia and pulmonary existing at the same time, syndrome of deficiency in origin and excess in superficislity. so the treatment of the body arthralgia symptoms and pulmonary symptoms should be balanced.
3.IPF is more common to older men. They have less body arthralgia symptoms but more pulmonary symptoms, and the lung function decreased significantly, with severe condition and poor prognosis. so the therapy should focus on how to adjust the organs function of lung and kidney, improve the symptom of pulmonary and prolong survival based.
引文
[1]李聪甫校注.中藏经校注[M].北京：人民卫生出版社,1990：75-76.
[2]黄帝内经素问[M].北京：人民卫生出版杜,1963：353.
[3]赵佶.圣济总录[M].北京：人民卫生出版社，1982：473-481,496-498,987-989.
[4]朱棣.普济方[M].北京：人民卫生出版社,1983：2431-2439,2449-2452.
[5]王肯堂.证治准绳[M].上海：上海卫生出版社,1957：253-254.
[6]秦景明,秦之桢.症因脉治[M].上海：上海科技出版杜,1990：104.
[7]李中梓.医宗必读[M].山西：山西科学技术出版社,2006：357-359.
[8]张介宾.类经[M].北京：人民卫生出版社,1965：193,558.
[9]王子接.绛雪同古方选注[M].北京：中国中医药出版社,1993：77.
[10]陈士铎.辨证录[M].北京：人民卫生出版社,1989.81-93.
[11]上海中医学院.痿痹专辑[M].上海：上海科技出版杜,1987：164.
[12]沈金鳌,杂病源流犀浊[M],北京：中国中医药出版社,1994：196.
[13]林佩琴.类证治裁[M].北京：人民卫生出版社,1988：269.
[14]叶天士.临证指南医案[M].上海：上海人民卫生出版社,1976.
[15]叶天士著,徐灵胎评.临证指南医案[M].上海：上海人民出版社,1976：291-295.
[16]路志正,焦树德,阎孝诚.痹病论治学[M].北京：人民卫生出版社,1989：18.
[17]蒋连泓.痹病临床经纬[M].天津：天津科学技术出版社,1993：148-150.
[18]李经纬,邓铁涛.中医大辞典[M].北京：人民卫生出版社,1995：951,785,339,1533.
[19]谢观.中华医学大辞典[M].沈阳：辽宁科技出版杜,1994：872.
[20]童学彪.五脏痹实质探讨[J].南京中医药大学学报,1996,12(6)：6-7.
[21]董振华.从《内经》五脏痹理论探讨风湿病多系统损害的治疗[J].北京中医，2006,25(6)：347-350.
[22]王进全,李玺.内经类证论治[M].西安：陕西科技出版杜,1987：242-244.
[23]王承德,沈丕安,胡荫奇.实用中医风湿病学[M].北京：人民卫生出版社,2009：400-404.
[24]《中医大辞典》编辑委员会.简明中医辞典[M].北京：人民卫生出版社,1986：557.
[25]李菊莲,王宇,邓海娟等.肺痹与肺间质纤维化关系探讨[J].甘肃科技,2003,19(12)：113-114.
[26]王玉光,周平安,刘清泉肺痹证治新诠[J].中国中医基础医学杂志,2000,8(7)：6-7.
[27]姚楚芳,林意菁,蒋树龙.浅谈肺痹与肺间质纤维化[J].中西医结合学报，2004,2(4)：295-296.
[28]马君.关于肺纤维化中医命名的思考[J].现代中西医结合杂志,2007,16(13)：1763-1763,1773.
[29]廖远芬.肺纤维化中医病名探讨[J].辽宁中医学院学报,2003,5(3)：225-225.
[30]李志铭.痹证论[M].广东：广东科技出版社.1987：2,55-56.
[31]陈瑞,王鹏.浅谈肺痹与特发性肺纤维化的关系[J].中国中医药信息杂志,2005,12(6)：90-91.
[32]盛刚,郭珍,任月朗,等.从肺痹论治特发性肺间质纤维化[J].山东中医药大学学报,2008,32(1)：25-26.
[33]侯杰.肺弥漫性疾病[M].南京：江苏科学技术出版社,1984：334-339.
[34]宋建平.肺痹古今论[J].中华医史杂志,1998,28(4)：212-214.
[35]张天篙,马君,韩镭.赵子贤辨治弥漫性肺间质纤维化经验[J].浙江中医杂志,1998,21(6)：69.
[36]王步青,薛勤梅.肺络理论与肺纤维化关系探讨[J].中国中医药信息杂志,2008,15(11)：93-94.
[37]刘正才,尤填义.中医免疫[M].重庆出版杜,1983：15.
[38]赵兰才,武维屏,肺间质纤维化的中医研究进展述评[J].北京中医药大学学报,2000,23(4)：70-72.
[39]赵正孝,吴娅娜,蔡光先.浅探《黄帝内经》脏腑痹的证与治[J].湖南中医学院学报,2004,24(2)：29-30,39.
[40]路志正,焦树德.实用中医风湿病学[M].北京：人民卫生出版社,1996.
[41]侯杰,戴令娟,黄妹,等.川芎嗪、丹参治疗大鼠肺纤维化对Ⅰ、Ⅲ型前胶原基因表达的影响[J].中华结核和呼吸杂志,1999,22(1)：43-45.
[42]李学军,崔社怀.三七总甙对大鼠肺纤维化过程中血浆MIP-1α、 MCP-1含量的影响[J].第三军医大学学报,2003,25(6)：522-524.
[43]江瑛,祁鑫,李长天,等.消风除湿胶囊对大鼠肺纤维化影响的实验研究[J].甘肃中医学院学报,2001,18(1)：16-18.
[44]钟殿胜,朱元钰,郭子健,等.雷公藤T4单体治疗肺纤维化的实验研究[J].中华内科杂志,1997,36(8)：546.
[45]仝润芍.血府逐瘀汤加减治疗弥漫性间质性肺炎46例[J].河南中医.1996,16(4)：233.
[461周晓园,陶凯,顾振东.肺通治疗放化疗所致肺间质纤维化10例[J].实用中西医结合杂志,1997,10(19)：1924.
[47]张恒,董怡,张奉春结缔组织病肺间质病变的临床特点分析[J].中华风湿病学杂志,1999,3(4)：246-248.
[1]蔡柏蔷,彭敏,贾宁.协和呼吸病学[M].北京：中国协和医科大学出版社,2005：1505.
[2]American Thoracic, Society, European Respiratory Society.American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee,June 2001[J]. Am J Respir Crit Care Med,2002,165:277-304.
[3]Strange C,Highland KB.Interstitial lung disease in the patient who has connectivet issue disease[J]. Clin Chest Med,2004,25:549-559.
[4]Bouros D, Wells AU, Nicholson AG,et al. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome[J]. Am J Respir Crit Care Med,2002,165(12):1581-1586.
[5]Carmona L, Gonzalez-Alvaro I, Balsa A, Angel Belmonte M, Tena X, Sanmarti R. Rheumatoid arthritis in Spain:occurrence of extra-articular manifestations and estimates of disease severity[J]. Ann Rheum Dis,2003,62(9):897-900.
[6]张恒,董怡,张奉春.结缔组织病肺间质病变的临床特点分析[J].中华风湿病学杂志,1999,3：247-248.
[7]周亚欧,左晓霞,游运辉,等.皮肌炎／多发性肌炎肺间质病变的临床及相关因素分析[J].中华风湿病学杂志,2005,9：318-319.
[8]宋淑菊,马骥良,潘丽恩,等.类风湿关节炎患者肺间质病变的临床研究[J].中华风湿病学杂志,2005,9：81-85.
[9]刘涛,宋良文.肺纤维化发生的分子机制和早期防治研究进展[J].军事医学科学院院刊,2003,27：312-316.
[10]叶任高,陆再英.内科学[M].第6版.北京：人民卫生出版社,2004,92-93.
[11]Marie I, Hachulla E, Ch6rin P, et al.Interstitial lung disease in polymyositis and dermatomyositis[J]. Arthritis Rheum,2002,47:614-622.
[12]Sato H, Lagan AL, Alexopoulou C,et al.The TNF-863A allele strongly associates with anticentromere antibody positivity in scleroderma[J]. Arthritis Rheum,2004,50:558-564.
[13]郭强,顾越英,黄文群,等.系统性红斑狼疮患者525例肺部病变的调查[J].中华风湿病学杂志,2004,8：364.
[14]Veeraraghavan S,Nicholson A G,Wells A U.Lung fibrosis:new classifications and therapy[J].Curr Opin Rheumato 1,2001,13:500-504.
[15]Vassallo R, Thomas CF. Advances in the treatment of rheumatic interstitial lung disease[J]. Curr Opin Rheumatol,2004,16(3):186-191.
[16]Lee HK,KIM DS,Yoo B,et al.Histopathologic pattern and clinical features of rheumatoid arthritis-associated interstitial lung disease[J].Chest,2005,127:2019-2027.
[17]朱然,马晓春,赵丽娟,等.结缔组织病致肺间质疾病病理改变类型的推断[J].中华结核和呼吸杂志,2005,28(5)：353-354.
[18]Fischer A, Meehan RT, Feghali-Bostwick CA, West SQ Brown KK. Unique characteristics of systemic sclerosis sine scleroderma-associated interstitial lung disease[J]. Chest,2006, 130(4):976-981.
[19]李海云,郑毅.结缔组织病合并间质性肺疾病的的研究进展[J].中华风湿病学杂志,2005,9：438-441.
[20]张烜.结缔组织病肺间质病变的诊治进展[J].中华医学信息导报,2007,22(5)：21-22.
[21]李光.结缔组织病相关的间质性肺疾病的研究进展[J].中国医药导报,2007,4(12)：15-16.
[22]Macdonald SLRubens MB,Hansell DM,et al.Nonspecific interstitial pneumonia and usual interstitial pneumonia:comparative appearances and diagnostic accuracy of thin-section CT[J].Radiology,2001,221:600-605.
[23]Latsi P I,Wells AU,Evaluation and management of alveolitis and interstial lung disease in scleroderoderma[J].Curt Opin Rheumatol,2003,15:748-755.
[24]heema GS,Quismorio FP Jr.Interstitial lung disease in systemic sclero-sis[J].Curr Opin Pulm Med,2001,7:283-290.
[25]姚婉贞,韩荣藓.结缔组织疾病的肺功能观察[J].结核与胸部肿瘤.1990,53(1)：45-47.
[26]钟南山.间质性肺疾病[A].见：叶任高.内科学[M].第6版.北京：人民卫生出版社,2005：92.
[27]杨南萍,税宗伦,左川,等.风湿病肺间质病变与层粘连蛋白和Ⅲ型前胶原的关系[J].中华风湿病学杂志,2001,5(1)：39-41.
[28]Ohnishi H,Yokoyama A,Kondo K,et al.Comparative study ofKL-6,surfactant protein-A,surfactant protein-D,and monocyte chemoatt ractant protein21 as serum markers for interstitial lung diseases[J].Am J Respir Crit Care Med,2002,165(3):378-381.
[29]Kumanovics Q Minier T, Radics J, et al. Comprehensive investigation of novel serum markers of pulmonary fibrosis associated with systemic sclerosis and dermato/polymyositis [J].Clin Exp Rheumatol,2008,26:414-420.
[30]Latsi PI,Wells AU.Evaluation and management of alveolitis and interstitial lung disease in scleroderma[J]. Curr Opin Rheumatol,2003,15:748-755.
[31]Renzoni E,Rottoli P,Coviello Qet al.Clinical laboratory and radi-ological fingings in pulmonary fibrosis with and without connective tissue disease[J].J ClinRheumatol,1997,16 (6):570-57.
[32]akas I,Ioannidis J A,Malagari K,et al.Cyclophosphamide with low or high dose prednisolone for systemic sclerosis lung disease[J].J Rheumatol,2002,29:298-304.
[33]Villeneuve E, St-Pierre A, Haraoui B. Interstitial pneumonitis associated with infliximab therapy[J]. J Rheumatol,2006,33:1189-1193.
[34]Demedts M, Behr J, Buhl R,et al. High-dose acetylcysteine in idiopathic pulmonary fibrosis[J]. N Engl J Med,2005,353(21):2229-2242.
[35]Raghu QJohnson W C,Lockhart D,et,al.Treatment of idiopathic pulmonary fibrosis with a new antifibrotic agent,pirfenidone:results of aprospective,open-label Phase Ⅱ study[J].Am J Respircrit Care Med,1999,15(9):1061-1062.
[36]吴燕燕.INF-γ在肺损伤纤维化中的研究[J].进展国外医学分册,2003,30(4)：213-215.
[37]周彩存,刘德纯,王凤超.γ干扰素和吲哚美辛对实验性肺纤维化的影响[J].中华结核和呼吸杂志,1999,22(2)：199.
[38]iesche R,Hofbauer E,Wittmann K,et al.A preliminary study of long term treatment with interfero gammal and low dose prednisolone in painents with idiopathic pulmonary fibrosis[J].N Engl J Med,1999,34(1):1264-1269.
[39]李永春,何冰,王海斌,等.红霉素对肺纤维化大鼠核因子κB活性及细胞因子mRNA表达的影响[J].中华结核和呼吸杂志,1999,22(12)：725-727.
[40]陈建,何冰,李永春,等.阿奇霉素对肺间质纤维化大鼠干预作用的研究[J].中华内科杂志,1999,38(10)：677-680.
[41]Ichimiya T,Takeoka K,Hiramatsu K,et al.The influence of azithro Mycin on the biofilm formation of pseudomonas aeruginosa in vitro[J]. Chemother,1996,42(3):186-191.
[42]中华医学会呼吸病学分会,特发性肺间质纤维化诊断和治疗指南草案[J],中华结核和呼吸杂志,2002,25(7)：387-389.
[43]Matsusaka T,Katori H,Inagami T,et al.Communication between myocytes and Marshall RP,Mc Anulty RJ,Laurent GJ.Angiotens in Ⅱis mitogenic for human lung fibrosis via activation of the type 1 recetor[J].Am J Respir Crit Care Med,2000,16(1):1999-2004.
[44]夏蕾,徐启勇,叶燕青.大鼠肺纤维化中细胞间粘附分子的表达及卡托普利对其影响[J].临床内科杂志,2003,20(9)：495-496.
[45]方向群,朱元珏,胡晓玲,等.氯沙坦对大鼠肺纤维化模型的干预作用剂对MCP1和bFGF的表达的影响[J].中华结核和呼吸杂志,2002,25(5)：268-272.
[46]李楠,何冰,马靖.辛伐他汀对大鼠肺成纤维细胞的影响观察.[J]心肺血管病杂志,2002,21(2)：105-108.
[47]赵峰,戚好文,叶江枫,等.氟伐他汀对大鼠肺纤维化的治疗作用[J].解放军医学杂志,2004,(8)：703-706.
[48]徐作军.特发性间质性肺炎的诊治进展[J].中国实用内科杂志,2007,27：1.
[49]李京红,何冰,翁保迎.转化生长因子-β1单克隆抗体对大鼠肺纤维化的治疗观察[J].中华结核和呼吸杂志,1997,20(6)：347-349.
[50]Vassallo R,Maneson E,Thomas CF,et al.Chinical response of rheumatoid arthritis associated pulmonary fibrosis to tumor necrosis factor-Ct inhibition[J].Chest,2002,122: 1093-1096.
[51]Atsui T, Inui N, Suda T, et al. Anti-endothelialcell antibodies in patients with interstitial lung diseases[J]. Respir Med,2008,102:128-133.
[52]田欣伦,朱元珏.特发性肺间质纤维化与继发于结缔组织病的肺间质病的临床比较[J].中华老年医学杂志,2004,5(23)：5.
[53]Renzoni E,Rolvroli P,Coviello Qet al.Clinical.laboratory and radiological findings in pulmonary fibrosis with and without connective tissue disease[J].Clin Rheumatol,1997,16 (6):570-577.
[54]Davidson B K,Kelly C A,Griffths I D.Tan year follow up of pulmonary function in patients with primary sjogren's syndrome[J].Ann Rheum Dis,2000,59(9):709-712.
[55]周怡,刘宇,张金花,等.不同病因肺间质病变肺功能变化的研究[J].中国医学工程,2007,15(11)：865-867,870.
[56]朱元钰,当代呼吸病学进展[M].北京：中国协和医科大学出版社,2008：198-199.
[57]Mittoo S,Gelber A C,Christopher-Stine L,et al.Ascertainment of collagen vascular disease in patients presenting with interstitial lung disease[J].Respiratory Medicine,2009,103: 1152-1158.
[1]董怡.干燥综合征[A].见：方圻.现代内科学[M].北京：人民军医出版杜,1995：3192,3252.
[2]Joseph P H,Gary W H.Pulmonary complications of collagen vascular Disease[J]. Annu Rev Med,1992,43:17-35.
[3]RichardM S.Clinical problems-scleroderma[J].Rheum Dis Clin North Am,1996,22:825-840.
[4]Tosep M QOscar M,Enric P,et al.Interstitial lung disease related to dermatomyositis-comparative study with patients without lung involvement[J].Rheumatol,1996,23:1921.
[5]Danieli MG, Fratieeli P, Franeeschini F, et al. Five-year follow-up of 165 Italian patients with undifferentiated connective tissue diseases[J]. Clin Exp Rheumatol,1999,17: 585-591.
[6]于润江.间质性肺病的诊断技术及其评价[J].中华结核和呼吸杂志,1994,17(1)：6-7.
[7]蒋连泓.痹病临床经纬[M].天津：天津科学技术出版社,1993：148-150.
[8]陈瑞,王鹏.浅谈肺痹与特发性肺纤维化的关系[J].中国中医药信息杂志,2005,12(6)：90-91.
[9]武维屏,赵兰才.肺间质纤维化中医证治探析[J].中医杂志,2002,43(5)；325-326.
[10]Bourke SC, Clague H. Review of cryptogenic fibrosing alveolitis, including current treatment guideline[J]. Postgrad Med J,2000,76:618-624.
[11]周怡,刘宇,张金花,等.不同病因肺间质病变肺功能变化的研究[J].中国医学工程,2007,15(11)：865-867,870.
[12]王玉光,周平安,刘清泉肺痹证治新诠[J].中国中医基础医学杂志,2000,8(7)：6-7.
[13]Well AU, Cullinan P, Hansell DM, et al. Fibrosing alveolitis associated with systemic sclerosis has a better prognosis than crytogenic pulmonary fibrosing alveolitis[J]. Am J Respir Crit Care Med,1994,149:1583-1590.
[2]黄帝内经素问[M].北京：人民卫生出版杜,1963：353.
[3]赵佶.圣济总录[M].北京：人民卫生出版社，1982：473-481,496-498,987-989.
[4]朱棣.普济方[M].北京：人民卫生出版社,1983：2431-2439,2449-2452.
[5]王肯堂.证治准绳[M].上海：上海卫生出版社,1957：253-254.
[6]秦景明,秦之桢.症因脉治[M].上海：上海科技出版杜,1990：104.
[7]李中梓.医宗必读[M].山西：山西科学技术出版社,2006：357-359.
[8]张介宾.类经[M].北京：人民卫生出版社,1965：193,558.
[9]王子接.绛雪同古方选注[M].北京：中国中医药出版社,1993：77.
[10]陈士铎.辨证录[M].北京：人民卫生出版社,1989.81-93.
[11]上海中医学院.痿痹专辑[M].上海：上海科技出版杜,1987：164.
[12]沈金鳌,杂病源流犀浊[M],北京：中国中医药出版社,1994：196.
[13]林佩琴.类证治裁[M].北京：人民卫生出版社,1988：269.
[14]叶天士.临证指南医案[M].上海：上海人民卫生出版社,1976.
[15]叶天士著,徐灵胎评.临证指南医案[M].上海：上海人民出版社,1976：291-295.
[16]路志正,焦树德,阎孝诚.痹病论治学[M].北京：人民卫生出版社,1989：18.
[17]蒋连泓.痹病临床经纬[M].天津：天津科学技术出版社,1993：148-150.
[18]李经纬,邓铁涛.中医大辞典[M].北京：人民卫生出版社,1995：951,785,339,1533.
[19]谢观.中华医学大辞典[M].沈阳：辽宁科技出版杜,1994：872.
[20]童学彪.五脏痹实质探讨[J].南京中医药大学学报,1996,12(6)：6-7.
[21]董振华.从《内经》五脏痹理论探讨风湿病多系统损害的治疗[J].北京中医，2006,25(6)：347-350.
[22]王进全,李玺.内经类证论治[M].西安：陕西科技出版杜,1987：242-244.
[23]王承德,沈丕安,胡荫奇.实用中医风湿病学[M].北京：人民卫生出版社,2009：400-404.
[24]《中医大辞典》编辑委员会.简明中医辞典[M].北京：人民卫生出版社,1986：557.
[25]李菊莲,王宇,邓海娟等.肺痹与肺间质纤维化关系探讨[J].甘肃科技,2003,19(12)：113-114.
[26]王玉光,周平安,刘清泉肺痹证治新诠[J].中国中医基础医学杂志,2000,8(7)：6-7.
[27]姚楚芳,林意菁,蒋树龙.浅谈肺痹与肺间质纤维化[J].中西医结合学报，2004,2(4)：295-296.
[28]马君.关于肺纤维化中医命名的思考[J].现代中西医结合杂志,2007,16(13)：1763-1763,1773.
[29]廖远芬.肺纤维化中医病名探讨[J].辽宁中医学院学报,2003,5(3)：225-225.
[30]李志铭.痹证论[M].广东：广东科技出版社.1987：2,55-56.
[31]陈瑞,王鹏.浅谈肺痹与特发性肺纤维化的关系[J].中国中医药信息杂志,2005,12(6)：90-91.
[32]盛刚,郭珍,任月朗,等.从肺痹论治特发性肺间质纤维化[J].山东中医药大学学报,2008,32(1)：25-26.
[33]侯杰.肺弥漫性疾病[M].南京：江苏科学技术出版社,1984：334-339.
[34]宋建平.肺痹古今论[J].中华医史杂志,1998,28(4)：212-214.
[35]张天篙,马君,韩镭.赵子贤辨治弥漫性肺间质纤维化经验[J].浙江中医杂志,1998,21(6)：69.
[36]王步青,薛勤梅.肺络理论与肺纤维化关系探讨[J].中国中医药信息杂志,2008,15(11)：93-94.
[37]刘正才,尤填义.中医免疫[M].重庆出版杜,1983：15.
[38]赵兰才,武维屏,肺间质纤维化的中医研究进展述评[J].北京中医药大学学报,2000,23(4)：70-72.
[39]赵正孝,吴娅娜,蔡光先.浅探《黄帝内经》脏腑痹的证与治[J].湖南中医学院学报,2004,24(2)：29-30,39.
[40]路志正,焦树德.实用中医风湿病学[M].北京：人民卫生出版社,1996.
[41]侯杰,戴令娟,黄妹,等.川芎嗪、丹参治疗大鼠肺纤维化对Ⅰ、Ⅲ型前胶原基因表达的影响[J].中华结核和呼吸杂志,1999,22(1)：43-45.
[42]李学军,崔社怀.三七总甙对大鼠肺纤维化过程中血浆MIP-1α、 MCP-1含量的影响[J].第三军医大学学报,2003,25(6)：522-524.
[43]江瑛,祁鑫,李长天,等.消风除湿胶囊对大鼠肺纤维化影响的实验研究[J].甘肃中医学院学报,2001,18(1)：16-18.
[44]钟殿胜,朱元钰,郭子健,等.雷公藤T4单体治疗肺纤维化的实验研究[J].中华内科杂志,1997,36(8)：546.
[45]仝润芍.血府逐瘀汤加减治疗弥漫性间质性肺炎46例[J].河南中医.1996,16(4)：233.
[461周晓园,陶凯,顾振东.肺通治疗放化疗所致肺间质纤维化10例[J].实用中西医结合杂志,1997,10(19)：1924.
[47]张恒,董怡,张奉春结缔组织病肺间质病变的临床特点分析[J].中华风湿病学杂志,1999,3(4)：246-248.
[1]蔡柏蔷,彭敏,贾宁.协和呼吸病学[M].北京：中国协和医科大学出版社,2005：1505.
[2]American Thoracic, Society, European Respiratory Society.American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee,June 2001[J]. Am J Respir Crit Care Med,2002,165:277-304.
[3]Strange C,Highland KB.Interstitial lung disease in the patient who has connectivet issue disease[J]. Clin Chest Med,2004,25:549-559.
[4]Bouros D, Wells AU, Nicholson AG,et al. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome[J]. Am J Respir Crit Care Med,2002,165(12):1581-1586.
[5]Carmona L, Gonzalez-Alvaro I, Balsa A, Angel Belmonte M, Tena X, Sanmarti R. Rheumatoid arthritis in Spain:occurrence of extra-articular manifestations and estimates of disease severity[J]. Ann Rheum Dis,2003,62(9):897-900.
[6]张恒,董怡,张奉春.结缔组织病肺间质病变的临床特点分析[J].中华风湿病学杂志,1999,3：247-248.
[7]周亚欧,左晓霞,游运辉,等.皮肌炎／多发性肌炎肺间质病变的临床及相关因素分析[J].中华风湿病学杂志,2005,9：318-319.
[8]宋淑菊,马骥良,潘丽恩,等.类风湿关节炎患者肺间质病变的临床研究[J].中华风湿病学杂志,2005,9：81-85.
[9]刘涛,宋良文.肺纤维化发生的分子机制和早期防治研究进展[J].军事医学科学院院刊,2003,27：312-316.
[10]叶任高,陆再英.内科学[M].第6版.北京：人民卫生出版社,2004,92-93.
[11]Marie I, Hachulla E, Ch6rin P, et al.Interstitial lung disease in polymyositis and dermatomyositis[J]. Arthritis Rheum,2002,47:614-622.
[12]Sato H, Lagan AL, Alexopoulou C,et al.The TNF-863A allele strongly associates with anticentromere antibody positivity in scleroderma[J]. Arthritis Rheum,2004,50:558-564.
[13]郭强,顾越英,黄文群,等.系统性红斑狼疮患者525例肺部病变的调查[J].中华风湿病学杂志,2004,8：364.
[14]Veeraraghavan S,Nicholson A G,Wells A U.Lung fibrosis:new classifications and therapy[J].Curr Opin Rheumato 1,2001,13:500-504.
[15]Vassallo R, Thomas CF. Advances in the treatment of rheumatic interstitial lung disease[J]. Curr Opin Rheumatol,2004,16(3):186-191.
[16]Lee HK,KIM DS,Yoo B,et al.Histopathologic pattern and clinical features of rheumatoid arthritis-associated interstitial lung disease[J].Chest,2005,127:2019-2027.
[17]朱然,马晓春,赵丽娟,等.结缔组织病致肺间质疾病病理改变类型的推断[J].中华结核和呼吸杂志,2005,28(5)：353-354.
[18]Fischer A, Meehan RT, Feghali-Bostwick CA, West SQ Brown KK. Unique characteristics of systemic sclerosis sine scleroderma-associated interstitial lung disease[J]. Chest,2006, 130(4):976-981.
[19]李海云,郑毅.结缔组织病合并间质性肺疾病的的研究进展[J].中华风湿病学杂志,2005,9：438-441.
[20]张烜.结缔组织病肺间质病变的诊治进展[J].中华医学信息导报,2007,22(5)：21-22.
[21]李光.结缔组织病相关的间质性肺疾病的研究进展[J].中国医药导报,2007,4(12)：15-16.
[22]Macdonald SLRubens MB,Hansell DM,et al.Nonspecific interstitial pneumonia and usual interstitial pneumonia:comparative appearances and diagnostic accuracy of thin-section CT[J].Radiology,2001,221:600-605.
[23]Latsi P I,Wells AU,Evaluation and management of alveolitis and interstial lung disease in scleroderoderma[J].Curt Opin Rheumatol,2003,15:748-755.
[24]heema GS,Quismorio FP Jr.Interstitial lung disease in systemic sclero-sis[J].Curr Opin Pulm Med,2001,7:283-290.
[25]姚婉贞,韩荣藓.结缔组织疾病的肺功能观察[J].结核与胸部肿瘤.1990,53(1)：45-47.
[26]钟南山.间质性肺疾病[A].见：叶任高.内科学[M].第6版.北京：人民卫生出版社,2005：92.
[27]杨南萍,税宗伦,左川,等.风湿病肺间质病变与层粘连蛋白和Ⅲ型前胶原的关系[J].中华风湿病学杂志,2001,5(1)：39-41.
[28]Ohnishi H,Yokoyama A,Kondo K,et al.Comparative study ofKL-6,surfactant protein-A,surfactant protein-D,and monocyte chemoatt ractant protein21 as serum markers for interstitial lung diseases[J].Am J Respir Crit Care Med,2002,165(3):378-381.
[29]Kumanovics Q Minier T, Radics J, et al. Comprehensive investigation of novel serum markers of pulmonary fibrosis associated with systemic sclerosis and dermato/polymyositis [J].Clin Exp Rheumatol,2008,26:414-420.
[30]Latsi PI,Wells AU.Evaluation and management of alveolitis and interstitial lung disease in scleroderma[J]. Curr Opin Rheumatol,2003,15:748-755.
[31]Renzoni E,Rottoli P,Coviello Qet al.Clinical laboratory and radi-ological fingings in pulmonary fibrosis with and without connective tissue disease[J].J ClinRheumatol,1997,16 (6):570-57.
[32]akas I,Ioannidis J A,Malagari K,et al.Cyclophosphamide with low or high dose prednisolone for systemic sclerosis lung disease[J].J Rheumatol,2002,29:298-304.
[33]Villeneuve E, St-Pierre A, Haraoui B. Interstitial pneumonitis associated with infliximab therapy[J]. J Rheumatol,2006,33:1189-1193.
[34]Demedts M, Behr J, Buhl R,et al. High-dose acetylcysteine in idiopathic pulmonary fibrosis[J]. N Engl J Med,2005,353(21):2229-2242.
[35]Raghu QJohnson W C,Lockhart D,et,al.Treatment of idiopathic pulmonary fibrosis with a new antifibrotic agent,pirfenidone:results of aprospective,open-label Phase Ⅱ study[J].Am J Respircrit Care Med,1999,15(9):1061-1062.
[36]吴燕燕.INF-γ在肺损伤纤维化中的研究[J].进展国外医学分册,2003,30(4)：213-215.
[37]周彩存,刘德纯,王凤超.γ干扰素和吲哚美辛对实验性肺纤维化的影响[J].中华结核和呼吸杂志,1999,22(2)：199.
[38]iesche R,Hofbauer E,Wittmann K,et al.A preliminary study of long term treatment with interfero gammal and low dose prednisolone in painents with idiopathic pulmonary fibrosis[J].N Engl J Med,1999,34(1):1264-1269.
[39]李永春,何冰,王海斌,等.红霉素对肺纤维化大鼠核因子κB活性及细胞因子mRNA表达的影响[J].中华结核和呼吸杂志,1999,22(12)：725-727.
[40]陈建,何冰,李永春,等.阿奇霉素对肺间质纤维化大鼠干预作用的研究[J].中华内科杂志,1999,38(10)：677-680.
[41]Ichimiya T,Takeoka K,Hiramatsu K,et al.The influence of azithro Mycin on the biofilm formation of pseudomonas aeruginosa in vitro[J]. Chemother,1996,42(3):186-191.
[42]中华医学会呼吸病学分会,特发性肺间质纤维化诊断和治疗指南草案[J],中华结核和呼吸杂志,2002,25(7)：387-389.
[43]Matsusaka T,Katori H,Inagami T,et al.Communication between myocytes and Marshall RP,Mc Anulty RJ,Laurent GJ.Angiotens in Ⅱis mitogenic for human lung fibrosis via activation of the type 1 recetor[J].Am J Respir Crit Care Med,2000,16(1):1999-2004.
[44]夏蕾,徐启勇,叶燕青.大鼠肺纤维化中细胞间粘附分子的表达及卡托普利对其影响[J].临床内科杂志,2003,20(9)：495-496.
[45]方向群,朱元珏,胡晓玲,等.氯沙坦对大鼠肺纤维化模型的干预作用剂对MCP1和bFGF的表达的影响[J].中华结核和呼吸杂志,2002,25(5)：268-272.
[46]李楠,何冰,马靖.辛伐他汀对大鼠肺成纤维细胞的影响观察.[J]心肺血管病杂志,2002,21(2)：105-108.
[47]赵峰,戚好文,叶江枫,等.氟伐他汀对大鼠肺纤维化的治疗作用[J].解放军医学杂志,2004,(8)：703-706.
[48]徐作军.特发性间质性肺炎的诊治进展[J].中国实用内科杂志,2007,27：1.
[49]李京红,何冰,翁保迎.转化生长因子-β1单克隆抗体对大鼠肺纤维化的治疗观察[J].中华结核和呼吸杂志,1997,20(6)：347-349.
[50]Vassallo R,Maneson E,Thomas CF,et al.Chinical response of rheumatoid arthritis associated pulmonary fibrosis to tumor necrosis factor-Ct inhibition[J].Chest,2002,122: 1093-1096.
[51]Atsui T, Inui N, Suda T, et al. Anti-endothelialcell antibodies in patients with interstitial lung diseases[J]. Respir Med,2008,102:128-133.
[52]田欣伦,朱元珏.特发性肺间质纤维化与继发于结缔组织病的肺间质病的临床比较[J].中华老年医学杂志,2004,5(23)：5.
[53]Renzoni E,Rolvroli P,Coviello Qet al.Clinical.laboratory and radiological findings in pulmonary fibrosis with and without connective tissue disease[J].Clin Rheumatol,1997,16 (6):570-577.
[54]Davidson B K,Kelly C A,Griffths I D.Tan year follow up of pulmonary function in patients with primary sjogren's syndrome[J].Ann Rheum Dis,2000,59(9):709-712.
[55]周怡,刘宇,张金花,等.不同病因肺间质病变肺功能变化的研究[J].中国医学工程,2007,15(11)：865-867,870.
[56]朱元钰,当代呼吸病学进展[M].北京：中国协和医科大学出版社,2008：198-199.
[57]Mittoo S,Gelber A C,Christopher-Stine L,et al.Ascertainment of collagen vascular disease in patients presenting with interstitial lung disease[J].Respiratory Medicine,2009,103: 1152-1158.
[1]董怡.干燥综合征[A].见：方圻.现代内科学[M].北京：人民军医出版杜,1995：3192,3252.
[2]Joseph P H,Gary W H.Pulmonary complications of collagen vascular Disease[J]. Annu Rev Med,1992,43:17-35.
[3]RichardM S.Clinical problems-scleroderma[J].Rheum Dis Clin North Am,1996,22:825-840.
[4]Tosep M QOscar M,Enric P,et al.Interstitial lung disease related to dermatomyositis-comparative study with patients without lung involvement[J].Rheumatol,1996,23:1921.
[5]Danieli MG, Fratieeli P, Franeeschini F, et al. Five-year follow-up of 165 Italian patients with undifferentiated connective tissue diseases[J]. Clin Exp Rheumatol,1999,17: 585-591.
[6]于润江.间质性肺病的诊断技术及其评价[J].中华结核和呼吸杂志,1994,17(1)：6-7.
[7]蒋连泓.痹病临床经纬[M].天津：天津科学技术出版社,1993：148-150.
[8]陈瑞,王鹏.浅谈肺痹与特发性肺纤维化的关系[J].中国中医药信息杂志,2005,12(6)：90-91.
[9]武维屏,赵兰才.肺间质纤维化中医证治探析[J].中医杂志,2002,43(5)；325-326.
[10]Bourke SC, Clague H. Review of cryptogenic fibrosing alveolitis, including current treatment guideline[J]. Postgrad Med J,2000,76:618-624.
[11]周怡,刘宇,张金花,等.不同病因肺间质病变肺功能变化的研究[J].中国医学工程,2007,15(11)：865-867,870.
[12]王玉光,周平安,刘清泉肺痹证治新诠[J].中国中医基础医学杂志,2000,8(7)：6-7.
[13]Well AU, Cullinan P, Hansell DM, et al. Fibrosing alveolitis associated with systemic sclerosis has a better prognosis than crytogenic pulmonary fibrosing alveolitis[J]. Am J Respir Crit Care Med,1994,149:1583-1590.