疾病分期在47例特发性肺纤维化中的临床价值  

Value of clinical staging for idiopathic pulmonary fibrosis

作　　者：庄蝶微[1] 魏丽娟[1] 崔娜[1] 严梅[1] 王虹[1] 

机构地区：[1]北京市第六医院呼吸内科,100007

出　　处：《国际呼吸杂志》2013年第10期752-755,共4页International Journal of Respiration

摘　　要：目的了解GAP评分和分期系统对特发性肺纤维化（IPF）预后的临床价值。方法回顾性分析47例北京市第六医院住院明确诊断的IPF患者，27例完善支气管肺泡灌洗，对全部病例进行GAP指数评估及分期，分析各期患者生存情况及氧分压（POz）变化，了解各期患者的临床特征，并进一步评价预后。结果Ⅲ期IPF患者的3年及5年生存率分别为40．0％及30．0％，中位生存期为27．1个月，P02为（48．7±8．1）mmHg，明显低于Ⅰ、Ⅱ期（P〈0．01）；C反应蛋白为（27．4±17．5）mg／L，高于Ⅰ、Ⅱ期（P〈O．05）；支气管肺泡灌洗液（BALF）中中性粒细胞比例和嗜酸粒细胞比例分别为（9．9±3．O）％及（6．3±2．3）％，高于Ⅰ、Ⅱ期（P〈O．05或P〈O．01）。Ⅱ、Ⅲ期IPF患者肿瘤标记物异常及合并肺动脉高压的比例增多（P〈0．05或P〈O．01），Ⅲ期IPF患者急性发作发生率高于Ⅰ、Ⅱ期（P〈0．05）。血沉、职业暴露、吸烟及合并慢性阻塞性肺疾病、肺癌、反流性食管炎在各期分布差异无统计学意义（P〉O．05）。结论Ⅲ期IPF患者生存情况差，POz低下，C反应蛋白、BALF中中性粒细胞比例和嗜酸粒细胞比例升高，肿瘤标记物异常比例、并发肺动脉高压及急性发作发生率增多，临床预后不良。Objective To investigate the clinical value of GAP risk assessment system and staging for the prognosis evaluation of idiopathic pulmonary fibrosis. Methods The data of 47 patients with idiopathic pulmonary fibrosis were analysed retrospectively, in which bronchoalveolar lavage fluid were detected in 27 patients, risk evaluation on the basis of GAP risk assessment system and staging were conducted for all patients. Results Survival rate for three years and five years of the patients staged Ⅲ was 40.0% and 30.0% respectively, 27.1 months for mean survival time, （48.7 ± 8.1） mm Hg for arterial partial pressure of oxygen, which were inferior than that of staged Ⅰ and Ⅱ （ P d0.01）. There were higher level of C-reactive protein, neutrophil and eosinophil percent in bronchoalveolar lavage fluid, and acute episode frequency for the patients staged Ⅲ. Tumor marker abnormal ratio and complicating pulmonary artery hypertension were higher for the patients staged Ⅱ and Ⅲ. Conclusions Patients with idiopathic pulmonary fibrosis stagedⅢ have bad survival status and clinical prognosis.

关 键 词：特发性肺纤维化 GAP指数评估 分期 预后 

分 类 号：R563.9[医药卫生—呼吸系统]