老年特发性肺间质纤维化与肺纤维化和肺气肿综合征的临床特征比较

Comparative analysis on clinical characteristics of IPF and CPFE in elderly patients with pulmonary fibrosis

目的比较老年特发性肺间质纤维化(IPF)与老年肺纤维化和肺气肿综合征(CPFE)的临床特点及预后差异。方法将我院呼吸内科收治的30例患者分为IPF组(13例)和CPFE组(17例),比较两组患者入院时的肺功能、血气资料、影像学、血清转化生长因子β(TGF-β1)、血管内皮生长因子(VEGF)及预后的差异。结果 CPFE组与IPF组的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)比较差异无统计学意义(P>0.05);CPFE组的血氧饱合度(SaO2)低于IPF组、肺泡动脉氧分压差(P[A-a]O2)高于IPF组(P<0.05);CPFE组与IPF组的用力肺活量(FVC)、第1秒用力肺活量(FEV1)、肺总量(TLC)、FEV1/FVC比较差异有统计学意义(P<0.05);CPFE组的TGF-β1、VEGF均显著的低于IPF组(P<0.05)。两组在蜂窝表现、支气管牵拉扩张、纵膈淋巴结肿大、肺纤维化评分几项指标上差异无统计学意义(P>0.05);IPF组的网格影表现显著高于CPFE组(P<0.05);CPFE组的中位生存时间为18.0个月,IPF组的中位生存时间为23.0个月,IPF组的中位生存时间显著长于CPFE组(χ2=5.004,P<0.05)。结论 CPFE患者与IPF患者的临床血气指标、TGF-β1、VEGF等指标均有较为显著的差异,这有利于二者的鉴别诊断,同时CPFE患者的预后较IPF患者差。

ABSTRACT：Objective To compare the clinical features and prognostic differences of idiopathic pulmonary interstitial fibrosis（IPF）in elderly patients with pulmonary fibrosis and emphysema syndrome（CPFE）.Methods Thirty cases in our hospital were divided into group IPF （13 cases）and CPFE group （17 cases）,comparison was performed in pulmonary function and blood gas data,the image,serum transforming growth factor beta（TGF-beta 1）, vascular endothelial growth factor（VEGF）differences and prognosis of two groups.Results CPEE group compared with IPF group,arterial oxygen（PaO2 ）,arterial carbon dioxide tension（PaCO2 ）showed significant difference（P 〉0.05）;oxygen saturation（SaO2 ）in CPFE group was lower than that of IPF group,alveolar-arteri pressure（P[A-a]O2 ） higher than IPF group （P 〈0.05）;CPFE group compared with PIF group,forced vital capacity（FVC）,forced vital capatity in one second（FEV1 ）,total lung capacity（TLC）,FEV1/FVC had significant difference （P 〈0.05）;TGF-β1 , VEGF in CPFE group were significantly lower than those of IPF group（P 〈0.05）;the two groups had no significant difference in the cellular performance,bronchial dilation traction,mediastinal lymphadenopathy,pulmonary fibrosis score on several indicators （P 〉0.05）;the grid shadow performance of IPF group was significantly higher than that of CPFE group （P 〈0.05）;CPFE group,the median survival time of 18.0 months,with a median survival time of IPF group 23.0 months,the median survival time of IPF group was significantly longer than that of CPFE group （χ2 =5.004,P 〈0.05）.Conclusion The difference of clinical blood gas indexes,TGF-beta,VEGF index of CPFE group in comparison with IPF group were significant,which is conducive to the differential diagnosis of the two diseases,at the same time,the prognosis of CPFE patients was poorer than that of IPF patients.