肺纤维化合并肺气肿与特发性肺纤维化临床特点的比较  

Comparison of the clinical features of combined pulmonary fibrosis and emphysema and idiopathic pulmonary fibrosis

作　　者：林敏杰 张英为[2] 陈露露[2] 刘小琴[2] 王艳泓 邱玉英[1] LIN Minjie;ZHANG Yingwei;CHENG Lulu;LIU Xiaoqing;WANG Yanhong;QIU Yuying(Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing,Jiangsu 210008,P.R.China;Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China)

机构地区：[1]南京医科大学鼓楼临床医学院呼吸与危重症医学科,江苏南京210008 [2]南京大学医学院附属鼓楼医院呼吸与危重症医学科,江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2020年第6期548-553,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的比较肺纤维化合并肺气肿(CPFE)和特发性肺纤维化(IPF)的临床特点。方法回顾性分析南京鼓楼医院2014年6月至2018年7月首次住院诊断为CPFE或IPF的患者83例,其中CPFE组47例,IPF组36例。比较两组的人口学特征、临床表现、肺功能、心脏超声、血气分析及预后情况。结果CPFE组的吸烟比例(89.4%)较IPF组(50.0%)高(P<0.05),呼吸困难的比例较低(P<0.05)。肺功能方面:CPFE组的FVC、FVC%pred、FEV1、FVC1%pred和VC%高于IPF组(P<0.05),IPF组的FEV1/FVC%pred高于CPFE组(P<0.05)。CPFE组的DLCO/VA%pred年下降速度显著快于IPF组(P<0.05),CPFE组的RV/TLC%pred逐年上升,IPF组逐年下降(P<0.01)。CPFE组的RV%pred逐年上升,IPF组逐年下降(P<0.05)。两组患者初诊时动脉血氧分压和肺动脉压无显著性差异。预后方面:CPFE组1年生存率为87.9%,3年生存率为73.8%,IPF组1年生存率为84.1%,3年生存率为65.8%,两组生存期差异未见统计学意义(P=0.95)。结论与IPF患者相比,CPFE患者的吸烟比例更高,呼吸困难比例相对较低,肺容积偏于正常,DLCO/VA%pred下降速度更快,预后无显著性差异。Objectives To compare the clinical features of combined pulmonary fibrosis and emphysema(CPFE)and idiopathic pulmonary fibrosis(IPF).Methods Eighty-three patients diagnosed as CPFE or IPF for the first time were retrospectively analyzed from June 2014 to July 2018 in Nanjing Drum Tower Hospital,including 47 patients in the CPFE group and 36 in the IPF group.The demographic characteristics,clinical manifestations,pulmonary function,cardiac ultrasound,blood gas analysis and prognosis of the two groups were compared.Results The proportion of smokers in the CPFE group was higher than IPF group(P<0.05),but dyspnea was lower(P<0.05).The FVC,FVC%pred,FEV1,FEV1%pred and VC%of the CPFE group were higher than IPF group(P<0.05),while FEV1/FVC%pred in the IPF group was higher than CPFE group(P<0.05).DLCO/VA%pred of CPFE group decreased more significantly than IPF group(P<0.05),RV/TLC%pred of CPFE group increased annually,while decreased annually in IPF group(P<0.01).The RV%pred of CPFE increased annually,while that of IPF group decreased annually(P<0.05).There was no significant difference in arterial oxygen pressure and pulmonary artery pressure between the two groups.As for prognosis,the 1-and 3-year survival rate of the CPFE group were 87.9%and 73.8%respectively,those of the IPF group were 84.1%and 65.8%respectively,and no significantly difference was observed between two groups(P=0.95).Conclusions Compared with IPF,patients with CPFE usually have more smokers,less proportion of dyspnea,almost normal lung volume,more rapidly decreased DLCO/VA%pred,and no significant difference in prognosis.

关 键 词：肺纤维化合并肺气肿 特发性肺纤维化 临床特征 

分 类 号：R563[医药卫生—呼吸系统]