肺纤维化合并肺气肿在社区肺癌高危人群筛查项目中的流行病学研究  

The epidemiological study of combined pulmonary fibrosis and emphysema in a community-based lung cancer screening program

作　　者：许飞 陈群慧[3] 张海[1] 高振云 王晓辉[4] 陈宇清 张岩巍 韩宝惠[1] 李锋 XU Fei;CHEN Qunhui;ZHANG Hai;GAO Zhenyun;WANG Xiaohui;CHEN Yuqing;ZHANG Yanwei;HAN Baohui;LI Feng(Department of Pulmonary and Critical Care Medicine,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,P.R.China;Department of Internal Medicine,Shanghai Electric Power Hospital,Shanghai 200050,P.R.China;Department of Radiology,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,P.R.China;Department of Pharmacy,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,P.R.China)

机构地区：[1]上海交通大学附属胸科医院呼吸与危重症医学科,上海200030 [2]上海电力医院内科,上海200050 [3]上海交通大学附属胸科医院放射科,上海200030 [4]上海交通大学附属胸科医院药剂科,上海200030

出　　处：《中国呼吸与危重监护杂志》2021年第10期709-714,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家重点研发计划专项(2018 YFC1313604)。

摘　　要：目的研究肺纤维化合并肺气肿(CPFE)在上海市基于社区肺癌高危筛查人群中的患病率。方法从2018年6月至2019年7月,上海市徐汇区的符合社区肺癌高危筛查条件的人群接受胸部低剂量CT扫描。对于疑似CPFE患者进行病史问询、抽血化验、高分辨率CT(HRCT)扫描以确定诊断。结果在4478名受试者中,男1704名,女2774名,有15例疑似CPFE病例,其中4例拒绝检查,11例接受进一步检查。8例(1.79‰)被确认为CPFE,均为男性,其中2例患者既往有吸烟史,6例患者目前仍吸烟。CPFE患者均有活动后咳嗽、胸闷、呼吸困难。胸部HRCT显示,肺气肿表现为小叶中央型肺气肿3例,间隔旁型肺气肿2例,全小叶型肺气肿1例,混合型肺气肿2例;间质性肺病表现为普通间质性肺炎2例,非特异性间质性肺炎3例,肺泡扩大伴纤维化2例,不可分类的吸烟相关性肺纤维化1例。King简易间质性肺病问卷总分为(61.7±7.5)分,改良英国MRC呼吸困难得分为(1.5±0.8)分。血清涎液化糖链抗原浓度为(380.75±212.05)U/mL。肺功能检查为正常或轻度限制性通气功能障碍,伴轻–中度弥散功能障碍。结论CPFE的患病率在基于社区肺癌高危筛查人群中为1.79‰,在肺癌高危筛查男性人群中为4.69‰。Objective To study the prevalence of combined pulmonary fibrosis and emphysema(CPFE)in a community-based lung cancer screening program in Shanghai.Methods From June 2018 to July 2019,eligible participants who were assessed through a high-risk lung cancer questionnaire in Xuhui,Shanghai underwent low-dose computed tomography of the lungs.The suspected CPFE patients were invited to provide medical history and blood for analysis,and received high-resolution CT(HRCT)scanning for confirmation.Results Of the 15 cases of suspected CPFE from a total of 4478 participants in which 1704 males and 2774 females,4 declined further examination and 11 received further examine.Eight subjects were confirmed as CPFE,and all were male,of whom two were ex-smokers and six were active smokers.These CPFE patients had cough,chest tightness and dyspnea.There were 3 cases of centrilobular emphysema,2 cases of paraseptal emphysema,1 case of panlobular emphysema and 2 cases of mixed emphysema.There were 2 cases of usual interstitial pneumonia,3 cases of non-specific interstitial pneumonia,2 cases of airspace enlargement with fibrosis and 1 case of unclassifiable smoking-related interstitial fibrosis.The KBILD scores were 61.7±7.5 and mMRC scores were 1.5±0.8.Serum Krebs von den Lungen-6 concentration was(380.75±212.05)U/mL.Lung function test showed normal or mild restrictive ventilatory function,and mild-moderate impairment in diffusion capacity.Conclusions The prevalence of CPFE is 1.79‰in a community-based lung cancer screening population,and is 4.69‰in male lung cancer screening population.

关 键 词：肺纤维化合并肺气肿 肺癌筛查 患病率 

分 类 号：R563[医药卫生—呼吸系统] R734.2[医药卫生—内科学]