非活动性肺结核对肺纤维化合并肺气肿患者的影响

Effects of inactive pulmonary tuberculosis on patients with combined pulmonary fibrosis and emphysema

目的探讨非活动性肺结核对肺纤维化合并肺气肿(CPFE)患者临床特征的影响。方法采用胸部高分辨率CT(HRCT)进行筛选,有非活动性肺结核表现的CPFE患者作为观察组(n=42),仅符合CPFE表现的患者作为对照组(n=38);采用视觉评分量化纤维化、肺气肿和非活动性肺结核。按非活动性肺结核评分将观察组再分为≥10分组(n=18)和<10分组(n=24)。比较各组血气分析指标、肺功能指标、HRCT表现和评分。结果与对照组比较,观察组第一秒用力肺活量与用力肺活量的比值<70%的发生率较高(28/42),25%的最大呼气流量和最大呼气中段流量较低,≥10分组还有50%最大呼气流量更低(均P<0.05);各组间肺气肿评分、纤维化评分、动脉氧分压的差异无统计学意义(均P>0.05)。结论非活动性肺结核可加重CPFE患者气流受限。

Objective To investigate the effects of inactive tuberculosis on the clinical features of patients with combined pulmonary fibrosis and emphysema（ CPFE）. Methods The high resolution computer tomography（ HRCT） was adopted to screen the patients. Patients were divided into the observation group（ CPFE patients with inactive pulmonary tuberculosis, n = 42） and control group（ CPFE patients, n = 38）. The visual semi-quantitative scoring system was employed to quantify fibrosis, emphysema, and inactive tuberculosis. According to scores of inactive pulmonary tuberculosis, the observation group was further divided into the ≥10 points group（ n = 18） and 10 points group（ n = 24）. Indexes of arterial blood gas analysis, indexes of pulmonary function, and HRCT manifestation and scores of groups were compared. Results Compared with the control group, patients of the observation group whose ratios of forced expiratory volume in first second to forced vital capacity that were less than70% were more（ 28 /42）, and the maximal expiratory flow of 25% vital capacity and maximal middle expiratory flow were lower. Furthermore, the maximal expiratory flow of 50% vital capacity of the ≥10 points group was even lower（ P〈0. 05）. The differences of the emphysema score, fibrosis score, and arterial oxygen pressure of groups were not statistically significant（ P〉0. 05）. Conclusion Inactive tuberculosis can aggravate the airflow obstruction of patients with CPFE.