慢性阻塞性肺疾病合并肺间质纤维化43例临床分析

Clinical analysis of 43 cases of chronic obstructive pulmonary disease with idiopathic pulmonary fibrosis

目的:探讨慢性阻塞性肺疾病合并肺间质纤维化(PF-COPD)的特点及临床意义.方法:对2002年3月～2005年3月我院收治的经临床确诊的43例PF-COPD患者和43例特发性肺间质纤维化(IPF)患者的临床表现、X线检查、CT片/高分辨CT(HRCT)、肺功能及血气检查结果进行回顾性分析.结果:(1)PF-COPD的临床表现介于IPF、COPD之间.双肺湿哕音、桶状胸、肺界下移、肺心病体征2组差异有统计学意义(P＜0.05);Velcro哕音、杵状指(趾)2组差异无统计学意义(P＞0.05).(2)X线检查及CT兼有上述IPF、COPD的特点.X线检查胸廓增大、肺透亮度增高、肺纹理紊乱2组之间差异有统计学意义(P＜0.05),而肺纤维化征象(即网状/网状结节、磨玻璃改变、蜂窝改变)2组之间差异无统计学意义(P＞0.05).CT检查肺大泡、肺泡壁破坏两组之间差异有统计学意义(P＜0.05);肺纤维化征象(即网状/网状结节、磨玻璃改变、蜂窝改变、胸膜下线征)2组之间差异无统计学意义(P＞0.05).(3)肺功能测定结果不完全符合单纯阻塞性或限制性通气功能障碍,多为混合性通气功能障碍.2组用力肺活量(FVC)、第一秒用力呼气量(FEV1)、第一秒用力呼气量占用力肺活量的百分率(FEV1%)差异均有统计学意义(P＜0.05);2组一氧化碳弥散量(DLCO)差异无统计学意义(P＞0.05).(4)血气分析表现以低氧血症为主,部分可合并二氧化碳潴留.2组动脉氧分压(PaO2)差异无统计学意义(P＞0.05);2组动脉二氧化碳分压(PaCO2)差异有统计学意义(P＜0.05).结论:PF-COPD具其有独特的临床表现,使原来单一的疾病表现不典型.胸片、CT/HRCT、肺功能,尤其是HRCT对诊断COPD合并肺间质纤维化有重要价值.

Objective: To explore the clinical characteristics and clinical significance of chronic obstructive pulmonary disease with pulmonary fibrosis (PF-COPD). Methods: Forty-three patients with PF-COPD were retrospectively analyzed by patients history, clinical symptoms, chest radiograph, CT/HRCT, lung function test and blood-gas analysis and to compare with Forty-three patients with idiopathic pulmonary fibrosis(IPF).Results: (1)Clinical characteristics of PF-COPD were between that of COPD and IPF.There was statistical significance of moist rales 、tubbiness thorax、lung boundary descend(P<0.05); crackles, finger clubbing was nothing statistical(P>0.05).(2)Chest radiograph and CT was between COPD and pulmonary fibrosis . There was statistical significance of emphysema characteristics; diffuse linear(P<0.05),reticular and fine nodular was nothing statistical(P>0.05).(3)Lung function test showed mixed ventilation disturbances. There was statistical significance of FVC, FEV1, FEV 1%(P<0.05); DLCO was nothing statistical (P>0.05). (4)Hypoxemia was main manifestations of arterial blood-gas analysis for PF-COPD, part coexisted with hypercarbia. There was statistical significance of PaO\-2(P<0.05); PaCO\-2 was nothing statistical(P>0.05). Conclusion: PF-COPD has unique clinical manifestation. Chest radiograph, CT/HRCT, lung function test are valuable tools to diagnose PF-COPD.