肺间质纤维化合并肺气肿的影响因素分析及其风险预测评估模型的建立  

Analysis of Influencing Factors and Risk Prediction Model Establishment of Pulmonary Interstitial Fibrosis Complicated with Emphysema

作　　者：张威[1] 聂秀红[1] 杨强[1] 李艳[1] ZHANG Wei;NIE Xiuhong;YANG Qiang;LI Yan(Department of Respiratory and Critical Care Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院呼吸与危重症医学科,北京100053

出　　处：《医学综述》2020年第22期4557-4561,4567,共6页Medical Recapitulate

摘　　要：目的分析肺间质纤维化合并肺气肿的影响因素,并建立列线图风险评估模型。方法选取2017年1月至2019年12月于首都医科大学宣武医院就诊的71例肺间质纤维化合并肺气肿患者作为观察组,选取同期收治的104例单纯肺间质纤维化患者作为对照组。比较两组患者的基线资料、肺功能相关指标[第一秒用力呼气量占预计值百分比(FEV 1%pred)、用力肺活量占预计值百分比(FVC%pred)、第一秒用力呼气量与用力肺活量之比(FEV 1/FVC%)、肺总量占预计值百分比(TLC%pred)、残气量占预计值百分比(RV%pred)、潮气量占预计值百分比(VT%pred)、一氧化碳弥散量占预计值百分比(DLCO%pred)]和静息状态下的动脉血氧分压(PaO 2)。采用多因素Logistic回归分析筛选出肺间质纤维化合并肺气肿的独立危险因素,对筛选出的独立危险因素建立列线图风险预测模型,并验证该模型的预测性及准确性。结果观察组患者有吸烟史的比例低于对照组[64.79%(46/71)比79.81%(83/104)],有反流性食管炎和慢性肾脏疾病患者的比例高于对照组[71.83%(51/71)比56.73%(59/104),77.46%(55/71)比51.92%(54/104)](P<0.05)。观察组患者的FEV 1/FVC%、DLCO%pred低于对照组[(70±6)比(81±5),(46±11)比(57±17)],TLC%pred、VT%pred高于对照组[(75±9)比(67±8),(70±10)比(64±9)](P<0.05)。多因素Logistic回归分析结果显示,吸烟史、反流性食管炎、FEV 1/FVC%、TLC%pred、VT%pred和DLCO%pred为肺间质纤维化合并肺气肿的独立危险因素(P<0.05)。基于各危险因素,建立预测肺间质纤维化合并肺气肿风险的列线图模型,并对列线图模型进行验证,列线图模型预测肺间质纤维化合并肺气肿发生风险的一致性指数为0.853(95%CI 0.817~0.889),受试者工作特征曲线下面积为0.879。结论吸烟史、反流性食管炎、FEV 1/FVC%、TLC%pred、VT%pred和DLCO%pred为肺间质纤维化合并肺气肿的独立影响因素,建立的列线图风险预测模型�Objective To analyze the influencing factors of pulmonary interstitial fibrosis complicated with emphysema,and establish nomogram risk model for evaluation.Methods A total of 71 patients with pulmonary interstitial fibrosis complicated with emphysema in Xuanwu Hospital,Capital Medical University from Jan.2017 to Dec.2019 were included as an observation group,and 104 patients with simple pulmonary interstitial fibrosis during the same period were included as a control group.Baseline data,lung function related indicators[percentage of forced expiratory volume in first second as predicted(FEV 1%pred),percentage of predicted forced vital capacity(FVC%pred),forced expiratory volume in first second/forced vital capacity(FEV 1/FVC%),total lung capacity of the predicted(TLC%pred),residual volume of the predicted(RV%pred),tidal volume of the predicted(VT%pred),and diffusing capacity of the lung for carbon monoxide of the predicted(DLCO%pred)]and arterial partial pressure of oxygen(PaO 2)in resting state were compared between the two groups.Multivariate Logistic regression analysis was used to screen out the independent risk factors of pulmonary interstitial fibrosis complicated with emphysema,the nomogram risk prediction model was established based on the screened risk factors,and the predictability and accuracy of the model was verified.Results The proportion of patients with smoking history in the observation group was lower than that in the control group[64.79%(46/71)vs 79.81%(83/104)],and the proportion of patients with reflux esophagitis and chronic kidney disease was higher than that of the control group[71.83%(51/71)vs 56.73%(59/104),77.46%(55/71)vs 51.92%(54/104)](P<0.05).FEV 1/FVC%and DLCO%pred in the observation group were lower than those in the control group[(70±6)vs(81±5),(46±11)vs(57±17)],TLC%pred and VT%pred were higher than those in the control group[(75±9)vs(67±8),(70±10)vs(64±9)](P<0.05).Multivariate Logistic regression analysis showed that smoking history,reflux esophagitis,FEV 1/FVC%,TLC%pred,V

关 键 词：肺气肿 肺间质纤维化 影响因素 风险预测评估模型 

分 类 号：R563[医药卫生—呼吸系统]