肺纤维化合并肺气肿和单纯慢阻肺肺气肿临床特点比较

Comparison of clinical characteristics between emphysema complicated with pulmonary interstitial fibrosis and simple emphysema

目的探讨肺纤维化合并肺气肿和单纯慢阻肺肺气肿临床特点。方法选取2014年5月至2017年5月我院收治的40例肺纤维化合并肺气肿患者作为研究组,同期收治的40例单纯慢阻肺肺气肿患者作为对照组,比较两组临床表现、胸部高分辨率CT(High resolution CT,HRCT)影像学表现、肺功能、血气分析指标、随访时间、治疗方式及死亡情况比较。结果 (1)对照组活动后呼吸困难、双下肺爆裂音、杵状指发生率均明显低于研究组,两组比较有显著差异性(P<0.05);(2)两组FEV1/FVC与动脉血氧分压比较无显著差异性(P>0.05);研究组肺总量高于对照组,但弥散功能低于对照组,两组比较有显著差异性(P<0.05);(3)研究组肺气肿表现:小叶中心型24例(60.00%),间隔旁型5例(12.50%),肺大疱8例(20.00%);肺间质纤维化表现:磨玻璃影18例(45.00%),网格影20例(50.00%)。对照组肺气肿表现:小叶中心型5例(12.50%),间隔旁型10例(25.00%),全小叶型9例(22.50%)、瘢痕旁型12例(30.00%);(4)两组治疗方式、死亡率以及随访时间比较差异无显著性(P>0.05)。结论肺纤维化合并肺气肿患者的临床表现(活动后呼吸困难、双下肺爆裂音及杵状指)更复杂,肺总量增大,弥散功能降低,预后差。

Objective To investigate the clinical characteristics of emphysema complicated with pulmonary fibrosis and simple chronic obstructive pulmonary emphysema. Methods 40 cases with emphysema complicated with pulmonary interstitial fibrosis in our hospital from May 2014 to May 2017 were selected as the study group,and 40 cases with chronic obstructive pulmonary emphysema at the same period were selected as the control group. The clinical manifestations,chest high resolution CT（ high resolution CT,HRCT） imaging findings,pulmonary function,blood gas analysis index,the survival time,treatment and death situation were compared between the two groups. Results（ 1） The activities of dyspnea,double lung crackles and acropachy in the control group were significantly lower than those in the study group（ P〈0. 05）.（ 2） The levels of FEV1/FVC and Pa O2 had no significant difference between the two groups（ P〈0. 05）. The total amount of lung volume in the study group was higher than that in the control group,but the diffusion function was lower than that in the control group（ P〈0. 05）.（ 3） The emphysema performance in the study group included 24 cases（ 60. 0%） of centrilobular,5 cases（ 12. 5%） of paraseptal type,and 8 cases（ 20. 0%） of pulmonary bullae. The performance of pulmonary interstitial fibrosis included 18 cases（ 45. 0%） of ground glass opacity,20 cases of（ 50%） shadow grid. In the control group,there were 5 cases（ 12. 50%） of pulmonary centrilobular,10 cases（ 25. 0%） of paraseptal type,9 cases（ 22. 50%） of total lobular type,and 12 cases（ 30%） of lobular scar type.（ 4） There was no significant difference in mortality,follow-up time or treatment method between the two groups（ P〈0. 05）. Conclusion The clinical manifestations of emphysema complicated with pulmonary interstitial fibrosis are more complicated than those of patients only with emphysema,such as dyspnea after breathing,double lung burst and clubbing fingers. The total lung volume is increased,the dispersion function is reduced,and the mortality is high in patients with emphysema complicated with pulmonary interstitial fibrosis.