纤维化性间质性肺病发生进展的危险因素分析  

Analysis of risk factors for the progression of fibrosing interstitial lung disease

作　　者：于文静 李永怀[1] 徐爱晖[1] YU Wenjing;LI Yonghuai;XU Aihui(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院呼吸与危重症医学科,安徽合肥230022

出　　处：《临床肺科杂志》2023年第7期1030-1035,共6页Journal of Clinical Pulmonary Medicine

基　　金：安徽医科大学校科研基金(No.2020xkj151);安徽省教育厅基金(No.KJ2021A0302)。

摘　　要：目的探讨常见纤维化性间质性肺病(fibrosing interstitial lung diseases,FILD)患者发生进展的危险因素及其意义,为临床诊疗提供参考。方法2019年1月-2022年6月安徽医科大学第一附属医院收治的FILD患者90例,过去一年内发生呼吸道症状恶化、肺功能或影像学进展的患者归为进展组(具体见方法),其余纳入稳定组,其中进展组27例,稳定组63例,收集患者一般情况、临床表现、血液检查结果、胸部CT等临床资料,采用单因素分析及多因素Logistics回归分析FILD患者发生进展的危险因素并探讨其意义。结果90例常见FILD患者中,多发性肌炎/皮肌炎所占比例(21例,23.3%)高于系统性硬化(15例,16.7%)、类风湿关节炎(12例,13.3%)及系统性红斑狼疮(8例,8.9%);呼吸系统症状如咳嗽(58例,64.4%)、气短(52例,57.7%)、咳痰(49例,54.4%)较常见。进展组平均年龄(65.2±12.6)岁,男性为主(14例,51.9%);稳定组平均年龄(56.3±10.6)岁,女性为主(50例,79.4%)。单因素分析显示性别(P=0.003)、年龄(P=0.001)、肺动脉压力(P<0.001)、嗜中性粒细胞百分比(P<0.001)、淋巴细胞百分比(P<0.001)、白蛋白(P<0.001)、总胆红素(P<0.001)、直接胆红素(P<0.001)、间接胆红素(P<0.001)、血小板计数(P=0.034)、C-反应蛋白(P<0.001)与FILD患者发生进展相关;多因素Logistics回归分析显示,总胆红素(OR=0.255,P=0.001,95%CI:0.118~0.552)、年龄(OR=1.111,P=0.018,95%CI:1.018~1.212)是FILD发生进展的危险因素。结论年龄大、总胆红素越低是FILD患者发生进展的危险因素,对疾病诊疗具有参考意义。Objective To explore the risk factors and significance of progression in patients with common fibrosing interstitial lung diseases(FILD),so as to provide reference for clinical diagnosis and treatment.Methods A total of 90 FILD patients admitted to the First Affiliated Hospital of Anhui Medical University from January 2019 to June 2022 were classified as the progressive group(see methods for details),and the rest were included in the stable group,with 27 cases in the progressive group and 63 in the stable group.Clinical data such as general situation,clinical manifestations,blood test results and chest CT were collected.Univariate analysis and multi-factor Logistics regression were used to analyze the risk factors for the progression of FILD patients and to explore their significance.Results Among 90 patients with common FILD,the proportion of polymyositis/dermatomyositis(21 cases,23.3%)was higher than that of systemic sclerosis(15 cases,16.7%),rheumatoid arthritis(12 cases,13.3%)and systemic lupus erythematosus(8 cases,8.9%).Respiratory symptoms such as cough(58 cases,64.4%),shortness of breath(52 cases,57.7%)and sputum(49 cases,54.4%)were more common.The mean age of the progressive group was(65.2±12.6)years old,and the majority of the patients were male(14 cases,51.9%).The mean age of the stable group was(56.3±10.6)years,and the majority of the patients were females(50 cases,79.4%).Univariate analysis showed that sex(P=0.003),age(P=0.001),pulmonary artery pressure(P<0.001),percentage of neutrophils(P<0.001),percentage of lymphocyte(P<0.001),albumin(P<0.001),total bilirubin(P<0.001),direct bilirubin(P<0.001),indirect bilirubin(P<0.001),platelet count(P=0.034),C-reactive protein(P<0.001)was associated with progression in patients with FILD;Multi-factor logistic regression analysis showed that total bilirubin(OR=0.255,P=0.001,95%CI:0.118~0.552)and age(OR=1.111,P=0.018,95%CI:1.018~1.212)were risk factors for FILD progression.Conclusion Older age and low total bilirubin are risk factors for progression of FILD pat

关 键 词：纤维化性间质性肺病 进展 危险因素 总胆红素 

分 类 号：R563[医药卫生—呼吸系统]