不同病因肺间质病变肺功能变化的研究

Study of pulmonary functional changes in interstitial lung disease patients with different pathogeny

目的寻找不同病因致弥漫性肺间质病变的肺功能改变及其变化规律。方法观察弥漫性肺间质病变54例的肺通气功能、弥散功能、肺毛细血管有效血流量、血气变化及肺CT影像学改变,并按发病时间长短分3组观察肺活量(vital capacity,VC)、一氧化碳弥散量(diffusing capacity of the lung for carbon monoxide,Dlco)、肺毛细血管有效血流量(pulmonary capillary blood flow,CO)异常检出率。结果发现这组病人的VC、残气量(residual volume,RV)、肺总量(total lung capacity,TLC)、一秒钟用力呼气容量(forced expiratory volume in one second,FEV1.0)、Dlco、CO降低,与正常组比差异非常显著(P≤0.01);其中特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)患者在发病的1年内的VC、Dlco、CO阳性率分别达66.6%、91.6%、50.0%,非特异性间质肺炎(non-specific interstitial pneumonia,NSIP)肺功能改变VC、Dlco、CO阳性率达18.1%、72.7%、50.0%。而结缔组织病致肺间质病变在发病的中、晚期的VC、Dlco、CO阳性率分别为33.3%、33.3%、50.0%。结论不同原因肺间质病变的肺功能改变可有限制性或混合性通气功能障碍;在弥散功能障碍的同时,伴肺毛细血管有效血流量减少。在特发性肺纤维化、非特异性间质肺炎发病早期VC、Dlco、CO就已降低,而结缔组织病致肺间质病变却在疾病中、晚期降低。Dlco检测是弥漫性肺间质病变这组疾病诊断的敏感指标。

[Objective] To explore the pulmonary function changes and its rules in interstitial lung disease （ILD） patients with different pathogeny. [Methods] Pulmonary ventilatory function, diffuse function, pulmonary capillary blood flow （CO） of 54 patients with ILD were measured. Meanwhile, CT scan was performed. These patients were divided into three groups to find positive rates of VC, Dleo, CO according to diseases progression. [Results] Vital capacity （VC）, Residual volume （RV）, total lung capacity （TLC）, forced expiratory volume in one second （FEV1.0）, diffusing capacity of the lung for carbon monoxide （Dleo）, CO of patients with ILD were deereaed in comparison with healthy controls. It had been found that the positive rates of VC, Dleo, CO in patients with IPF was high early in a year, such as VC to 66.6%, Dleo to 91.6%, CO to 50.0%. The positive rates were VC for 18.1%, Dleo for 72.2%, CO for 50.0% in patients of NSIP, But these positive rates of connective tissue disease （CTD） with ILD was higher in late stage. The positive rates of VC and Dleo were 33.3% and CO was 50.0% in patients of CTD with intertitial lung disease. [Conclusions] Pulmonary functional changes of ILD patients are restrictive or mixed ventilatory function defeet, diffusing function defect, and CO decreaed. High positive rates of VC, Dleo, CO in IPF and NSIP are found in early stages （≤1 year）. While positive rates of VC, Dleo, CO were found in late stage in patients of STD with ILD. It is care for clinic doctors that Dleo is a sensitive index for patients of ILD in diagnosis.