特发性肺纤维化患者生存预后因素的回顾性分析

Retrospective analysis of the prognosis factors in patients with idiopathic pulmonary fibrosis

目的探讨临床指标、肺生理变化及BALF细胞分类对判断特发性肺纤维化（IPF）患者预后的价值，评估糖皮质激素或糖皮质激素联合细胞毒类药物治疗IPF患者的影响。方法65例IPF患者分别接受临床评估和血气分析、肺功能、胸部高分辨率CT、心脏超声及BALF检查，分析各项指标对判断IPF患者预后的意义。采用Cox比例风险回归评价各指标的死亡危险度，采用KaplamMeier检验进行组间生存率比较。结果在平均随访38个月内，IPF患者的总体生存率为43．1％，确诊后的中位生存期为39个月；体重指数、杵状指、ESR、氧合指数、SaO2、肺总量占预计值％、DLCO占预计值％、肺动脉压和BALF中的中性粒细胞百分率是IPF患者预后的影响因素，其死亡危险度为0．842～1．945，Wald值为3．782—12．963，均P〈0．05；体重指数、杵状指、ESR、氧合指数、肺总量占预计值％和DLCO占预计值％的组问生存率比较，差异均有统计学意义（Log—rank值为3．907—10．452，均P〈0．05）；采用糖皮质激素治疗和糖皮质激素联合细胞毒类药物治疗的IPF患者与未采用上述药物治疗的IPF患者组间生存率比较，差异无统计学意义（Log—rank值为2．405，P〉0．05）。结论体重指数、杵状指、ESR、氧合指数、肺总量占预计值％和DLCO占预计值％对IPF患者的生存预后可能具有参考价值，糖皮质激素或糖皮质激素联合细胞毒类药物治疗不能改变IPF患者的预后。

Objective To investigate the prognostic implications of clinical and physiological variables, and the cellular classification of bronchoalveolar lavage fluid （BALF） in patients with idiopathic pulmonary fibrosis （IPF）. The effect of treatment with glucocortieoids with or without cytotoxic drugs was also evaluated. Methods The significauces of clinical, arterial blood gas analysis, pulmonary function test, lung high-resolution computed tomography, echoeardiography and BALF in the prognosis of patients with IPF were assessed in 65 patients with IPF at diagnosis. Univariate Cox proportional-hazards regression analysis was used to evaluate the various parameters associated with hazard ratio. The survival rates of all groups were compared using the Kaplau-Meier method. Results In 38 months of average follow-up time, the survival rate of the patients was 43. 1%, and the median survival time was 39 months after diagnosis. Univariate Cox proportional-hazards regression analysis showed that body mass index, clubbing fingers, ESR, PaO2/FiO2 , SaO2 , TLC%, DLCO%, pulmonary arterial pressure and the percent of neutrophil in BALF were factors that affected the prognosis of the patients with IPF （ HR O. 842 - 1. 945, Wald 3.782 12. 963, P 〈0. 05）. In the meanwhile, the patients were divided into 2 groups by the median of significant variables in univariate Cox proportional-hazards regression analysis （the cut off point value ）, and the survival rate group comparison showed statistically significant difference in body mass index, clubbing fingers, ESR, TLC% as well as DLCO% （ Log-rank 3. 907 - 10. 452, P 〈 0. 05 ）, while glucocorticoids with or without cytotoxic drugs for patients with IPF did not change the prognosis （ Log-rank 2. 405, P 〉 0. 05）. Conclusions Body mass index, clubbing fingers, ESR, PaO2/FiO2, TLC%, and DLCO% maybe the factors affecting the prognosis of patients with IPF, while glucocorticoids with or without cytotoxic drugs did not change the course of IPF.