老年人肺纤维化和肺气肿综合征临床特点研究  

Clinical features of combined pulmonary fibrosis and emphysema syndrome in elderly patients

作　　者：许小毛[1] 蒲纯[1] 杨翼盟 丁勇[1] 居阳[1] 崔佳[1] 孙铁英[1] 

机构地区：[1]卫生部北京医院呼吸与危重症医学科、北京医院呼吸病学研究中心,100730

出　　处：《中华老年医学杂志》2014年第2期129-133,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年肺纤维化和肺气肿综合征（CPFE）患者与特发性肺间质纤维化（IPF）患者的临床特点、肺功能、影像学和预后的差异。方法收集我院2000年1月至2012年10月诊断为IPF的老年患者88例，分为CPFE组和IPF组，比较两组患者的临床资料、血气分析、肺功能、影像学和生存时间的差异。结果共纳入30例CPFE患者和58例IPF患者，CPFE组患者平均年龄（75．5±7．6）岁，IPF组平均年龄（73．7±6．8）岁；CPFE组中男性患者比例（86．7％比63．8％）、吸烟史（28例比36例）和死亡患者所占比例（76．7％比43．1％）均高于IPF组（X2值=5．09、9．74、8．98，P=0．024、0．002、0．003）；CPFE组用力肺活量（FVC）[（2．6±0．9）L比（2．1±0．5）L3和肺总量（TLC）[（5．4±1．9）L比（4．4±1．1）L3较IPF组升高（t=2．69、2．35，P=0．009、0．025），而第1秒用力肺活量（FEV，）和一氧化碳弥散量（DLCO）在两组间差异无统计学意义；CPFE组中，90．0％患者高分辨cT（HRCT）显示上肺气肿病变类型为小叶中心型肺气肿；生存分析显示，CPFE组中位生存时间低于IPF组[（3．0±0．2）年比（4．0±1．O）年，X2=4．50，P=0．034]。结论老年CPFE患者以男性及吸烟患者居多，肺容积较IPF患者升高，肺气肿类型以小叶中心型肺气肿为主，其预后较IPF差。Objective To compare clinical features, pulmonary functions, chest imaging and prognosis between combined pulmonary fibrosis and emphysema syndrome （CPFE） and idiopathic pulmonary fibrosis（IPF） without emphysematous changes in elderly patients. Methods 88 elderly IPF patients in Beijing hospital from January 2000 to October 2012 were divided into CPFE （n=30） and IPF （n= 58） groups according to the CT imaging. Clinical features, blood gas analysis, pulmonary function, chest CT and survival time were compared between the two groups. Results 30 CPFE patients with the mean age of（75.5-±7.6） years and 58 IPF patients without emphysema with the mean age of（73.7 ± 6.8） years were enrolled. The proportions of male patients, smoking history and mortality were higher in CPFE patients than in IPF group（86.7O//oo vs. 63.8%, 28 vs. 36, 76.7% vs. 43.1% ,Z2 =5.09, 9.74, 8.98, P〈0.05 or 0.01）. CPFE patients had a higher force vital capacity（FVC） and total lung capacity（TLC） as compared with IPF group [（2.6±0.9） L vs. （2. l±0.5） L,（5.4±1.9） L vs. （4.4±1.1） L, t=2.69, 2.35, P〈0.01 or 0.051. There were no significant differences in forced expiratory volume in one second（FEV1） and the diffusion capacity for carbon monoxide（DLCO） between the two groups. The main type of emphysema by HRCT scan were centrilohular emphysema in CPFE patients. There were lower median survival time in CPFE group than in IPF group [（3.0±0.2） years vs. （4.0±1.0） years, Z2=4.50, P〈0.05]. Conclusions The majority of elderly CPFE patients are males and smokers. The lung volume is increased in elderly CPFE patients as compared with IPF patients. Centrilobular emphysema is the primary type in CPFE patients. The prognosis is worse in elderly CPFE patients than in IPF patients.

关 键 词：肺纤维化 肺气肿 

分 类 号：R563.3[医药卫生—呼吸系统]