弥漫性肺疾病395例临床分析  

Clinical analysis of 395 patients with diffuse lung diseases

作　　者：李惠萍[1] 黄建安[2] 范峰[3] 李霞[3] 余慧[3] 赵兰[3] 何国钧[3] 

机构地区：[1]苏州大学,215007 [2]苏州大学附属第一医院呼吸内科 [3]同济大学附属肺科医院呼吸科

出　　处：《上海医学》2007年第9期665-668,共4页Shanghai Medical Journal

基　　金：上海市卫生局重点课题(99405)

摘　　要：目的回顾性分析弥漫性肺疾病(DLD)患者的诊治情况,以提高临床医师对DLD的认识和诊治水平。方法回顾性分析1990年1月1日至2003年12月31日上海同济大学附属肺科医院收治的395例DLD住院患者的临床、影像学和病理等资料。结果本组395例DLD患者涉及的病种包括寻常型间质性肺炎(UIP)、非特异性间质性肺炎(NSIP)、脱屑型间质性肺炎(DIP)、呼吸性细支气管炎伴间质性肺病(RBILD)等10余种类型。其中,男190例,女205例,男女比例为0.93,女性稍多。以男性占优势的疾病主要包括UIP(男女比例为1.87)、弥漫性泛细支气管炎(DPB,男女比例为1.50)和RBILD(男女比例为1.33),以女性居多的病种主要包括隐原性机化性肺炎(COP,男女比例为0.25)、NSIP(男女比例为0.29)、结节病(男女比例为O.36)和胶原血管系统疾病(男女比例为0.24)等。随年龄增长DLD患病人数增加,>60岁者占36.2%。UIP以>50岁人群为主,占83.7%。1998年以后的6年收治的病例明显增加,占14年总病例数的85.3%(337/395例),活检例数占14年间的90.2%(92/102例)。有明确职业史者142例,占35.9%,其中农民占42.3%。吸烟者137例,占34.7%,吸烟率>40%的病种有肺泡细胞癌(72.7%)、DPB(60.0%)、RBILD(57.1%)和UIP(48.8%)。102例有活检资料的患者中,糖皮质激素治疗有效率为76.5%。不同病种的转归差别很大,DIP、COP、RBILD、DPB和结节病等的治疗有效率均达100.0%,NSIP为84.2%,UIP仅为40.0%。结论DLD患病率呈上升趋势,其发病的性别和年龄分布因不同病种而异。除UIP外,其他病种对糖皮质激素治疗的反应良好。DLD的病理活检率尚有待提高。Objective To retrospectively analyze the clinical data of patients with diffuse lung diseases （DLD）, so as to improve the understanding and diagnosis/treatment of DLD. Methods The clinical data, image data, and pathological data of DLD 395 patients who were treated in Shanghai Pulmonary Hospital（Affiliated to Tongji University） from Jan. 1990 to Dec. 2003 were retrospectively analyzed. Results The 395 DLD patients, 190 male and 205 female, included those with more than 10 types of diseases： the usual interstitial pneumonia （UIP）, nonspecific interstitial pneumonia （ NSIP）, cryptogenic organizing pneumonia（ COP）, desquamative interstitial pneumonia（ DIP）, respiratory bronchiolitis-associated interstitial lung disease （ RBILD）, etc. Male patients were more liable to have UIP（male to female ratio： 1.87） , diffuse panbronchiolitis（DPB, male to female ratio：l. 50）, and RBILD（male to female ratio：1. 33） ; female DLD patients were liable to have COP（male to female ratio：0.25）, NSIP（male to female ratio：0.29）, sarcoidosis（male to female ratio： 0.36）, connective tissue diseases related ILD（male to female ratio： 0.24）, etc. The incidence of DLD increased with age： 143 of 395 （36. 2%） patients were over 61, 36 of 43 （83. 7 %） patients with UIP were over 50. The number of DLD patients treated during the last 6 years was increased obviously, occupying 85.3% of the 395 patients; the number of biopsy was 92, being 90. 2% of the total 102 biopsy cases. A total of 142 patients（35. 9%） had some kinds of specific profession; 60 （42. 3%） of them were peasants. It was found that 137 （34. 7%） patients were smokers; DLD patients with smoking rate over 40% included those with lung cancer（72.7%）, DPB（60.0%）, RBILD（57. 1%） and UIP（48. 8%）. The response to steroid therapy was different in patients with different kinds of DLD. The response rate was 76.5%（78/102） in 102 patients who had lung biopsy, 100.0% in patients with DIP, C

关 键 词：弥漫性肺疾病 间质性肺疾病 特发性间质性肺炎 

分 类 号：R563.9[医药卫生—呼吸系统]