青年原发性自发性气胸非手术治疗后复发因素分析

Analysis on factors for recurrence after non-operative treatment of primary spontaneous pneumothorax in youth

目的探讨青年患者首次发作的原发性自发性气胸(PSP)非手术治疗后的复发因素,帮助临床医师筛选出高复发风险的患者,为行手术治疗提供依据。方法回顾性分析2010年1月至2014年10月首都医科大学附属北京友谊医院门急诊收治的首次发作的154例青年(15~40岁)PSP患者的病例资料。从患者的临床及影像学特征上研究青年PSP患者非手术治疗后复发的高危因素,临床特征从病历中提取,影像学特征从病人就诊时拍摄的胸部正侧位平片中提取,临床特征包括:性别、年龄、吸烟史、BMI,影像学特征包括:胸廓纵/横径比值、胸膜异常(主要包括胸膜不规则、胸膜增厚、胸膜粘连)。用Kaplan-Meier法对有胸膜异常的患者进行生存分析,用COX比例风险回归模型分析影响患者复发的因素。结果在随访期间,154例患者中,复发62例,复发率为40.2%,平均复发时间为32个月。临床特征方面:包括性别、年龄、吸烟史、BMI,这些基线特征在复发率上无显著性统计学差异(P>0.05)。影像学特征方面,X线上有胸膜异常者复发率为46.3%,X线无胸膜异常者复发率为26.1%,X线有胸膜异常较无胸膜异常复发率高,差异具有统计学意义(P<0.05)。结论 X线胸片提示有胸膜异常的首次发作的青年PSP患者较X线胸片上无胸膜异常的首次发作的青年PSP患者非手术治疗后复发率高,X线胸片提示有胸膜异常的首次发作的青年PSP患者可能更适于手术治疗。

Objective To explore the factors for recurrence of primary spontaneous pneumothorax （PSP） after first attack in young patients, and to help clinicians to screen out patients with high risk of recurrence, and provide basis for surgical treatment. Methods The clinical data of 154 young patients （15 to 40 years old） with PSP diagnosed in the emergency department of this hopital during January 2010 to October 2014 were retrospectively analyzed. The high-risk factors for relapse after non-surgical treatment of these young PSP patients and the clinical and imaging characteristics of these patients. were studied. The clinical features were extracted from their medical records. The imaging features were extracted from the Chest PA and LAT taken at the time of these patient＇s visit. Clinical features included： sex, age, smoking history, BMI, imaging features including： ratio of thoracic/lateral diameter, pleural abnormalities （mainly pleural irregularities, pleural thickeness and pleural adhesion）. Survival analysis was performed in patients with pleural abnormalities by using the Kaplan-Meier method, and factors influencing the recurrence of patients were analyzed by using COX proportional hazards regression model. Results During follow-up period, 62 of 154 patients relapsed with recurrence rate of 40.2% and an average relapse period of 32 months. Clinical features： including gender, age, smoking history and BMI, these baseline characteristics had no significant statistical difference in recurrence rate （ P 〉0.05）. In terms of imaging characteristics, the recurrence rate of pleural abnormalities on X-ray was 46.3%, and the recurrence rate of non-pleural abnormalities in X-ray examination was 26.1%. At baseline characteristics, X-ray abnormalities of pleural abnormalities were significantly higher than those without pleural abnormalities （ P =0.0193）, and the difference was statistically significant （ P 〈0.05）. Conclusion Chest X-ray examination revealed that the first episode of young PSP patients with pleural abnormalities had higher recurrence rate than those with non-surgical treatment for first-episode young PSP patients without pleural abnormalities on chest X-ray examination. The X-ray chest film showed the first episode of pleural abnormalities Young PSP patients may be more suitable for surgical treatment.