探讨老年肺间质纤维化合并肺气肿综合征的HRCT表现

The analysis of HRCT imaging characteristic for elderly in combined pulmonary fibrosis and emphysema(CPFE)

目的探讨老年肺间质纤维化合并肺气肿综合征(CPFE)的高分辨率CT(HRCT)表现。方法回顾性分析经临床确诊CPFE的患者(n=70)临床及影像学资料,并与慢性阻塞性肺疾病(COPD)患者(n=40)及特发性肺纤维化(IPF)患者(n=30)进行对比分析。结果肺气肿呈小叶中心型肺气肿26例(37.1%)、间隔旁型肺气肿62例(88.6%)、肺大疱型10例(14.4%)、全小叶型肺气肿4例(5.7%)。纤维化改变呈网格影者20例(57.1%)、蜂窝影者20例(28.6%)、磨玻璃影者38例(54.3%)、牵拉性支气管扩张者8例(11.4%)、胸膜下线者7例(10.0%)。另有21例(30%)患者表现出慢支合并肺间质改变。CPFE患者与COPD患者之间以间隔旁型肺气肿的差异具有统计学意义(P<0.05)。而CPFE的两肺纤维化影像形态学改变与IPF患者的差异无统计学意义(P>0.05),CPFE更多表现符合寻常型间质性肺炎或脱屑性间质性肺炎致肺内纤维化改变。结论 CPFE具有相对特异的HRCT表现,仔细观察肺气肿的类型、两肺纤维化表现形式以及两者之间的关系,可以对其做出快、精、准的影像学诊断。

Objective To analyze the feature of HRCT imaging about combined pulmonary fibrosis and emphysema （CPFE） in elderly people. Methods Retrospective analysis the CPFE patients （n = 70） who were diagnosed based on the clinical and imaging data, then compared the data of the COPD patients （n = 40） and the IPF patients （n = 30） Results The results shows that 26 patients （37.1%） can be diagnosed as centrilobular emphysema, 62 patients （88.6%） were paraseptal emphysema, 10 patients （14.4%） were lung bullous emphysema, 4 patients （5.7%） were panlobular emphysema. As for the changes of Pulmonary fibrosis, about 20 cases （57.1%） were reticular opactity, another 20 cases （28.6 %） were honeycombing opacity, ground-glass opacity were 38 cases （54.3 %）, tractional bronchiectasis were 8 cases （11.4 %）, pleural offline were 7 cases （10.0 %）. In addition, 21 patients were presented as chronic bronchitis combined with pulmonary interstitial fibrosis. It is common that CPFE is shown as paraseptal emphysema in which COPD patients are of statistically significant （P〈 0.05）. The fibrosis morphology imaging of two lungs for CPFE and IPF patients have no statistically significant （P〉 0.05）, where CPFE patients exhibit usual or desquamative interstitial pneumonia more often. Conclusion Therefore, CPFE has certainly specific CT performance. By means of detailly distinguishing the types of emphysema, the form of pulmonary fibrosis and their relationship, HRCT can provide critical evidence for clinical diagnose earlier, more quickly and precisely.