肺纤维化合并肺气肿肺功能及高分辨CT的特征  

Characteristics of pulmonary function and high-resolution CT imaging in combined pulmonary fibrosis and emphysema

作　　者：刘健群[1] 姜晶[1] 孟翠弟[1] 刘盛敏[1] 周秀梅[1] 关春爽[2] 

机构地区：[1]北京丰台医院呼吸科,100071 [2]北京丰台医院放射科,100071

出　　处：《国际呼吸杂志》2015年第2期109-113,共5页International Journal of Respiration

摘　　要：目的探讨肺纤维化合并肺气肿（CPFE）患者临床症状、体征、肺功能和高分辨CT（HRCT）的特征；分析肺纤维化和肺气肿的程度与肺功能之间的关系。方法前瞻性、随机临床病例对照研究。CPFE患者40例，COPD患者80例。比较两组患者一般特征及肺功能等，探讨CPFE肺纤维化和肺气肿的程度与肺功能之间的相关性。结果40例CPFE患者，年龄（71．8±8．1）岁，男33例，有吸烟史者36例。病程6个月至15年。临床主要症状为咳嗽（34例）、呼吸困难（32例）及双下肺部爆裂音（23例）。与COPD患者比较，CPFE患者Pa02降低（t=-2．016，P〈0．05）。与COPD患者比较，CPFE患者FEVl％pred[（72．7±20．0）％VS（53．8±15．6）％，t=5．687，P〈0．01]和FEV1／FVC[（70．4±15．8）％VS（54．3±10．7）％，t=6．590，P〈0．01]增高，RV％pred[（106．8±51．8）％VS（177．6±72．9）％，t=-5．484，Pd0．01]、TLc％pred[（90．1±22．5）％VS（135．4±86．2）％，t=-3．228，P〈0．01]和D1CO％pred[（43．6±19．4）％VS（63．5±16．1）％，t=-5．900，P〈0．01]降低；VC％pred和FVC％pred两组之间比较差异无统计学意义（t值分别为-0．876、0．450，P值均〉0．05）。CPFE患者胸部HRCT的主要表现为同时存在以双上肺野为主的肺气肿和双下肺野为主的肺间质改变。肺气肿表现为小叶中心型肺气肿（87．5％）、旁间隔型肺气肿（27．5％）、全小叶型肺气肿（10．0％）和肺大疱（35．0％）。肺间质改变为网格影97．5％，磨玻璃影55．0％，蜂窝肺37．5％。调整性别、年龄和吸烟混杂因素后，肺纤维化程度与D。CO％pred相关（P〈0．01），肺气肿严重程度与DLCO％pred和FEV1／FVC相关（P〈0．05）。结论CPFE多发生在男性吸烟者，肺通气功能受损较轻，而弥散功能显著下降。HRCT是CPFE诊断的主要依据。HRCT显示肺纤维化和肺气肿严重者肺弥散�Objective To investigate clinical symptom, sign, pulmonary function parameters and high-resolution CT in patients with combined pulmonary fibrosis and emphysema （CPFE）, and analyze the relationship between the pulmonary fibrosis and emphysema severity on high resolution CT and pulmonary function parameters. Methods A prospective,randomized,controlled study was performed. 40 CPFE patients and 80 COPD patients were selected. The common clinical features and pulmonary function parameters were compared between the two groups, and the relation of pulmonary fibrosis and emphysema severity with pulmonary function parameters of CPFE patients was analyzed. Results 40 CPFE cases were （71. 8±8.1） years old,33 of them were male,36 of them were smokers,and courses of disease were from six months to 15 years. The main clinical symptoms were cough （34 cases） ,dyspnea （32 cases） ,and double lung crackles （23 cases）. Compared with the COPD patients, PaO2 in CPFE patients decreased （ t = -2. 016, P d0.05）. The CPFE group showed significantly higher FEV1% pred [（72.7 ± 20.0） % vs （53.8±15.6） %, t =5. 687, P 〈0.01] and FEV1/FVCM [（70.4±15.8）% vs （54.3±10.7） %, t = 6. 590, P d0.01] compared with those of the COPD group, while RV% pred [（106.8± 51.8）% vs （177.6±72.9） % , t=-5.484, P〈0.01],TLC% pred [（90.1±22.5） % vs （135.4±86.2）%, t=-3. 228,P〈0.01],and DLCO%pred [（43.6±19.4）% vs （63.5±16.1）%, t =-5.900, P 〈0.01] were significantly lower in the CPFE group. There was no statistical difference in VC% pred and FVC% pred between the two groups （ t = -0. 876,0. 450, respectively, all P 〉0.05）. Characteristic radiologic findings in the CPFE included upper-lobe emphysema and lower-lobe interstitial fibrotic changes. The centrilohular emphysema, paraseptal emphysema, panlobuia emphysema, and bullous were present in 87.5%, 27.5% 10.0%, and 35.0%, respectively. The reticular opacities, ground-glass opacities, and honeycombing were present in 97.5%,55.0%, and

关 键 词：肺纤维化 肺气肿 呼吸功能试验 高分辨CT 

分 类 号：R563[医药卫生—呼吸系统]