特发性肺纤维化患者死亡预后因素的回顾性队列研究  

A retrospective cohort study of prognostic factors for death in patients with idiopathic pulmonary fibrosis

作　　者：李振华[1] 彭守春[1] 康健[1] 侯显明[1] 于润江[1] 

机构地区：[1]中国医科大学附属第一医院呼吸疾病研究所,沈阳110001

出　　处：《中华结核和呼吸杂志》2010年第12期887-891,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 探讨特发性肺纤维化（IPF）患者的临床、影像学和肺生理学指标与疾病预后的关系.方法 2000年1月至2004年6月在中国医科大学附属第一医院126例经临床诊断的IPF患者作为研究对象,其中男81例,女45例,年龄51～67岁,平均61岁.采用单因素和多因素Cox比例风险回归分析评估患者临床、呼吸生理、BALF及HRCT等参数的死亡风险度,采用Kaplan-Meier检验比较组间生存率.结果平均随访时间为29.6个月,IPF患者的生存率为46.8%（59/126）,确诊后的中位生存期为30个月.采用糖皮质激素和（或）细胞毒类药物治疗与采用其他药物治疗的生存率比较,差异无统计学意义（Ward值为2.3,P〉0.05）;性别和吸烟状态的组间生存率比较,差异无统计学意义（Ward值为0.11和1.65,均P〉0.05）.将单因素Cox比例风险回归分析结果中有意义的变量中位数为截点值,进行组间生存率比较,结果表明,呼吸困难评分、FVC、肺总量、DLCO、BALF中性粒细胞、嗜酸粒细胞、胸部HRCT网格影和蜂窝肺的组间生存率差异均有统计学意义（Logrank值为13.52～57.52,均P〈0.05）.多因素Cox比例风险回归分析结果表明,肺总量、DLCO、HRCT网格影和蜂窝肺均为影响IPF患者预后的因素（Ward值为5.76～74.20,均P〈0.01）.结论 肺总量、DLCO、BALF细胞学指标和肺纤维化程度是影响IPF患者预后的主要因素,其中肺总量和DLCO与IPF患者的预后呈负相关.糖皮质激素和（或）细胞毒类药物不能改变IPF患者的预后.Objective To investigate the prognostic implications of clinical,radiographic,and physiological variables in idiopathic pulmonary fibrosis （IPF）.Methods The clinical,pulmonary physiological,bronchoalveolar lavage fluid （BALF） cell differentials and lung high-resolution computed tomography （HRCT） at diagnosis in 126 patients with IPF were retrospectively analyzed.Univariate and multivariate Cox proportional-hazards regression analysis was used to evaluate various parameters associated with hazard ratio （HR）.The survival rates of all groups were compared using the Kaplan-Meier method.Results In 29.6 months of average follow-up time,the survival rate of the IPF patients was 46.8% （59/126）,and the median survival time was 30 months after diagnosis.Glucocorticoids and/or cytotoxic drugs for patients with IPF did not change the prognosis.The survival rates between groups by gender and smoking status showed no statistically significant difference （Ward：0.11,1.65,P〉0.05）.The patients were divided into 2 groups by the median （the cutoff point value）of significant variables in univariate Cox proportional-hazards regression analysis,and the survival rates showed statistically significant difference by dyspnea scale,FVC%,TLC%,DLCO%,neutrophil percentage and eosinophil percentate in BALF,and the reticular and honeycomb lung score （Logrank：13.52-57.52,P〈0.05）.The results of multivariate Cox proportional-hazards regression analysis showed that TLC%,DLCO%,HRCT reticular score and honeycomb lung score were factors that affected the prognosis of patients with IPF （Wald=5.76-21.48,P〈0.05）.Conclusions TLC%,DLCO%,cell differentials of BALF and the degree of pulmonary fibrosis were the main factors affecting the prognosis of patients with IPF.TLC% and DLCO% showed a negative correlation with the prognosis of patients with IPF.Glucocorticoids and/or cytotoxic drug therapy had no effect on the prognosis of patients with IPF.

关 键 词：肺纤维化 支气僻肺泡灌洗液 预后 

分 类 号：R686[医药卫生—骨科学]