原发性干燥综合征伴肺结节的临床特征

doi:10.3877/cma.j.issn.1674-6902.2025.05.002

目的

分析原发性干燥综合征(primary Sjögren′s syndrome, pSS)伴肺结节(pulmonary nodule, PN)的临床特征。

方法

回顾性分析2017年5月至2024年12月我院收治的32例pSS伴肺结节患者的临床资料、组织病理学检查结果及胸部CT影像学资料。

结果

32例中男3例(9.38%)，女29例(90.62%)，有吸烟史4例(12.50%)，临床表现口干26例、眼干12例和关节痛7例；呼吸道症状咳嗽、胸闷、胸痛和咯血13例；无呼吸道症状、体检肺部CT发现肺结节17例。免疫球蛋白(immunoglobulin, IgG)升高16例。组织病理学检查显示，良性病变10例(31.25%)，其中肺淀粉样变2例、肺肉芽肿炎2例，纤维钙化结节1例及炎性细胞浸润5例；肿瘤患者22例(68.88%)，其中肺癌17例，淋巴瘤4例，浆细胞瘤1例。良性病变者较肺癌和淋巴瘤患者呼吸道症状咳嗽、胸闷、胸痛和咯血常见(P<0.05)；淋巴瘤患者肺结节数多(P<0.05)；单个肺结节、磨玻璃样改变与肺癌相关。随访结束，32例中生存者26例(81.25%)，死亡者6例(18.75%)，其中因肺癌死亡者4例(12.50%)，淋巴瘤死亡者1例(3.12%)，良性病变死亡者1例(3.12%)；脑出血死亡者1例，5例为呼吸系统并发症相关死亡。

结论

pSS患者肺结节活检多为恶性肿瘤，单发结节及磨玻璃样改变常与肺癌相关，呼吸道症状多见于良性病变者。

关键词: 肺结节, 干燥综合征, 肺肿瘤, 淋巴瘤

Objective

To analyze the clinical characteristics of pulmonary nodules (PN) in patients with primary Sjögren′s syndrome (pSS).

Methods

A retrospective analysis was conducted on the clinical data, histopathological examination results, and chest CT imaging findings of 32 pSS patients with pulmonary nodules admitted to our hospital from May 2017 to December 2024.

Results

Among the 32 patients, 3 cases(9.38%) were male and 29 cases (90.62%) were female. Four patients (12.50%) had a history of smoking. Clinical manifestations included dry mouth 26 cases, dry eyes 12 cases, and arthralgia 7 cases. Respiratory symptoms (cough, chest tightness, chest pain, and hemoptysis) were present in 13 cases, while 17 cases had no respiratory symptoms and pulmonary nodules were discovered incidentally on physical examination CT. Immunoglobulin G (IgG) was elevated in 16 cases. Histopathological examination revealed benign lesions in 10 cases (31.25%), including pulmonary amyloidosis 2 cases, pulmonary granulomatous inflammation 2 cases, fibrocalcified nodules 1 case, and inflammatory cell infiltration 5 cases. Malignant tumors were found in 22 cases (68.88%), including lung cancer 17 cases, lymphoma 4 cases, and plasmacytoma 1 case. Respiratory symptoms (cough, chest tightness, chest pain, and hemoptysis) were significantly more common in patients with benign lesions compared to those with lung cancer or lymphoma (P<0.05). Patients with lymphoma had a significantly higher number of pulmonary nodules (P<0.05). Solitary pulmonary nodules and ground-glass opacity were associated with lung cancer. At the end of follow-up, 26 patients (81.25%) were alive, and 6 patients (18.75%) had died. Causes of death included lung cancer in 4 cases(12.50%), lymphoma in 1 case(3.12%), and benign lesions in 1 case(3.12%); one death was due to cerebral hemorrhage, and five were related to respiratory complications.

Conclusion

Malignant tumors are common findings in pSS patients with lung nodule biopsies. Solitary nodules and ground-glass opacity are frequently associated with lung cancer, while respiratory symptoms are more common in patients with benign lesions.

Key words: Pulmonary nodules, Sjogren′s syndrome, Lung tumor, Lymphoma

表1 pSS伴肺结节患者临床资料

临床资料	占比[n(%)]
呼吸道症状
咳嗽	11(34.38)
胸闷	6(18.75)
胸痛	2(6.25)
咯血	1(3.12)
ANA	24(75.00)
1︰100	1(3.12)
1︰320	7(21.88)
1︰1 000	9(28.12)
1︰3 200	7(21.88)
SSA(＋)	23(71.88)
SSB(＋)	9(28.12)
肺活检类型
气管镜	5(15.62)
经胸穿刺	11(34.38)
外科手术	16(50.00)

表1 pSS伴肺结节患者临床资料

临床资料	占比[n(%)]
呼吸道症状
咳嗽	11(34.38)
胸闷	6(18.75)
胸痛	2(6.25)
咯血	1(3.12)
ANA	24(75.00)
1︰100	1(3.12)
1︰320	7(21.88)
1︰1 000	9(28.12)
1︰3 200	7(21.88)
SSA(＋)	23(71.88)
SSB(＋)	9(28.12)
肺活检类型
气管镜	5(15.62)
经胸穿刺	11(34.38)
外科手术	16(50.00)

图1 pSS伴肺结节患者胸部CT扫描检查。图A为右肺下叶7 mm混杂磨玻璃结节，经手术肺活检诊断为微浸润腺癌；图B为右下肺边界欠清磨玻璃结节，经手术肺活检诊断为边缘区淋巴瘤；图C为左肺下叶分叶状结节影，局部包绕胸主动脉，病变区域支气管狭窄，经肺细针穿刺诊断为弥漫大B细胞淋巴瘤，生发中心源性；图D为双肺多发结节状高密度影，伴肺组织囊性变，经胸腔镜活检诊断为肺淀粉样轻链沉积；图E为右肺上叶一边界较清实性结节，18 mm×8 mm，经手术肺活检诊断为肉芽肿性炎；图F为右肺上叶不规则边界尚清高密度结节，可见分叶，23 mm×14 mm，其内可见点状钙化影，手术活检证实为纤维钙化结节；图G为左肺上叶类圆形高密度影，边缘见浅分叶，穿刺活检示多灶淋巴细胞、浆细胞浸润，并见较多碳末沉积；图H为右肺上叶类圆形高密度影，约10 mm，界清，经手术肺活检诊断为浆细胞瘤

表2 pSS伴肺结节患者组织病理学结果[n(%)]

组织病理学	构成[n(%)]
肺癌
肺腺癌	16(50.00)
肺鳞癌	1(3.12)
淋巴瘤
边缘区淋巴瘤	3(9.38)
弥漫性大B细胞淋巴瘤	1(3.12)
浆细胞瘤	1(3.12)
良性病变	10(31.25)
淀粉样变	2(6.25)
肉芽肿性炎	2(6.25)
纤维钙化	1(3.12)
炎性细胞浸润(淋巴细胞、浆细胞等)	5(15.62)

表2 pSS伴肺结节患者组织病理学结果[n(%)]

组织病理学	构成[n(%)]
肺癌
肺腺癌	16(50.00)
肺鳞癌	1(3.12)
淋巴瘤
边缘区淋巴瘤	3(9.38)
弥漫性大B细胞淋巴瘤	1(3.12)
浆细胞瘤	1(3.12)
良性病变	10(31.25)
淀粉样变	2(6.25)
肉芽肿性炎	2(6.25)
纤维钙化	1(3.12)
炎性细胞浸润(淋巴细胞、浆细胞等)	5(15.62)

图2 pSS伴肺结节患者病理学检查。图A为肺微浸润肺癌(HE染色，×200)；图B为弥漫性大B细胞淋巴瘤(HE染色，×200)；图C为浆细胞瘤(HE染色，×100)；图D为淀粉样变(HE染色，×200)

表3 pSS伴PNs患者亚组临床特征比较

临床特征	肺癌(n＝17)	淋巴瘤(n＝4)	良性病变(n＝10)	F值	P值
年龄[岁，(±s)]	57.58±11.16	60.25±6.95	52.00±12.55	1.082	0.353
性别[n(%)]					1.000
男	2(11.76)	0(0.00)	1(10.00)
女	15(88.24)	4(100.00)	9(90.00)
吸烟史[n(%)]	3(17.65)	0(0.00)	1(10.00)		1.000
呼吸道症状[n(%)]	2(11.76)	2(50.00)	9(90.00)		0.000
血常规[n(%)]
淋巴细胞数减少	7(41.18)	2(50.00)	5(50.00)		0.884
贫血	4(23.53)	1(25.00)	7(70.00)		0.060
血小板减少	3(17.65)	1(25.00)	1(10.00)		0.820
肺部CT影像
结节数[个，(±s)]	4.94±3.38	9.75±3.86	6.10±1.85	4.076	0.028
最大结节[mm，(±s)]	13.00±5.77	10.50±3.70	15.10±7.48	0.848	0.439
磨玻璃[n(%)]	14(82.35)	2(50.00)	1(10.00)		0.001
囊肿[n(%)]	1(5.88)	1(25.00)	3(30.00)		0.224
实变[n(%)]	2(11.76)	0(0.00)	3(30.00)		0.376
淋巴结增大[n(%)]	4(23.53)	1(25.00)	2(20.00)		1.000

表3 pSS伴PNs患者亚组临床特征比较

临床特征	肺癌(n＝17)	淋巴瘤(n＝4)	良性病变(n＝10)	F值	P值
年龄[岁，(±s)]	57.58±11.16	60.25±6.95	52.00±12.55	1.082	0.353
性别[n(%)]					1.000
男	2(11.76)	0(0.00)	1(10.00)
女	15(88.24)	4(100.00)	9(90.00)
吸烟史[n(%)]	3(17.65)	0(0.00)	1(10.00)		1.000
呼吸道症状[n(%)]	2(11.76)	2(50.00)	9(90.00)		0.000
血常规[n(%)]
淋巴细胞数减少	7(41.18)	2(50.00)	5(50.00)		0.884
贫血	4(23.53)	1(25.00)	7(70.00)		0.060
血小板减少	3(17.65)	1(25.00)	1(10.00)		0.820
肺部CT影像
结节数[个，(±s)]	4.94±3.38	9.75±3.86	6.10±1.85	4.076	0.028
最大结节[mm，(±s)]	13.00±5.77	10.50±3.70	15.10±7.48	0.848	0.439
磨玻璃[n(%)]	14(82.35)	2(50.00)	1(10.00)		0.001
囊肿[n(%)]	1(5.88)	1(25.00)	3(30.00)		0.224
实变[n(%)]	2(11.76)	0(0.00)	3(30.00)		0.376
淋巴结增大[n(%)]	4(23.53)	1(25.00)	2(20.00)		1.000

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[15]	王嘉巍, 张广健, 杜昊楠, 余宸傲, 张佳. 混合现实技术在肺结节手术中的应用进展[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 254-259.

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Clinical characteristics of primary Sjögren′s syndrome complicated with pulmonary nodules

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Clinical characteristics of primary Sjögren′s syndrome complicated with pulmonary nodules