老年人肺间质纤维化合并肺气肿综合征的临床特征及相关因素分析

Clinical features and related factors of combined pulmonary interstitial fibrosis and emphysema syndrome in the elderly

目的探讨老年肺间质纤维化合并肺气肿综合征(CPFE)的临床特点及发病的相关因素。方法选取北京医院于2015年1月至2020年1月入院的42例CPFE和83例特发性肺纤维化(IPF)老年患者进行回顾性研究,比较两组临床资料、实验室检查、影像学、肺功能及治疗转归的差异,分析一氧化碳弥散量(DLCO)与肺容量、肺通气指标的相关性,并采用多因素Logistic回归分析筛选相关危险因素。结果与IPF组患者比较,CPFE组的男性[78.6%(33/42)比50.6%(42/83)]、吸烟[78.6%(33/42)比45.8%(38/83)]和有过敏史[23.8%(10/42)比4.8%(4/83)]的患者比例显著更高(χ^(2)=9.090、12.219、8.293,P=0.003、0.000、0.004)。CPFE组的嗜酸粒细胞计数高于IPF组[0.17(0.12,0.25)×109/L比0.10(0.03,0.21)×109/L];肺功能方面,CPFE组的肺活量(VC)[2.60(2.18,3.08)L比1.99(1.48,2.63)L]、肺总量(TLC)[4.54(3.89,5.45)L比3.74(2.92,4.70)L]、用力肺活量(FVC)[2.46(2.12,3.08)L比1.95(1.43,2.58)L]、第1秒用力呼气量与用力肺活量之比(FEV1/FVC%)[84.18(75.59,88.83)%比80.94(69.07,83.08)%]的值均高于IPF组(Z=2.032、2.248、2.357、2.421、3.102,P=0.042、0.025、0.018、0.015、0.002)。相关性分析结果显示,IPF组患者的DLCO与残气量占预计值的百分比(RV%pred)、肺活量占预计值的百分比(VC%pred)、肺泡通气量占预计值的百分比(VA%pred)、肺总量占预计值的百分比(TLC%pred)、用力肺活量占预计值的百分比(FVC%pred)、第1秒用力呼气量占预计值的百分比(FEV1%pred)呈正相关(r=0.422、0.370、0.473、0.520、0.356、0.267,P=0.000、0.002、0.000、0.000、0.003、0.029),而在CPFE组中,DLCO与上述肺功能指标的相关性无统计学意义。多因素Logistic回归分析结果显示,吸烟(OR=5.421,95%CI:1.458~20.154,P=0.012)和过敏史(OR=7.458,95%CI:1.795~30.979,P=0.006)为CPFE的独立危险因素。结论老年CPFE患者的嗜酸粒细胞计数、肺容积较IPF患者升高,与肺通气、肺容量指标变化不相关的DLCO下降是其显著特征;吸烟、过敏史是老年CPFE患者的危险因素。

Objective To summarize the clinical characteristics and risk factors of combined pulmonary fibrosis and emphysema syndrome(CPFE)in the elderly.Methods 42 patients with CPFE and 83 patients with idiopathic pulmonary fibrosis(IPF)admitted to Beijing Hospital from January 2015 to January 2020 were included for this retrospective study,and their clinical data,laboratory test results,imaging,pulmonary function and treatment outcomes were compared.The correlations of diffusing capacity of the lungs for carbon monoxide(DLCO)with lung volume and other ventilation-related parameters were analyzed.Multivariate Logistic analysis was used to screen for risk factors.Results Compared with the IPF group,the proportions of patients who were male(78.6%or 33/42 vs.50.6%or 42/83),were smokers(78.6%or 33/42 vs.45.8%or 38/83)and had allergies(23.8%or 10/42 vs.4.8%or 4/83)were significantly higher in the CPFE group(χ^(2)=9.090,12.219,8.293,P=0.003,0.000,0.004,respectively).Eosinophil counts were significantly higher in the CPFE group than in the other group[0.17×109/L with a(0.12-0.25)×109/L range vs.0.10×109/L with a(0.03-0.21)×109/L range].In terms of pulmonary function tests,patients with CPFE had higher levels of vital capacity(VC)[2.60 L,range:(2.18-3.08)L vs.1.99 L,range:(1.48-2.63)L],total lung capacity(TLC)[4.54 L,range:(3.89-5.45)L vs.3.74 L,range:(2.92-4.70)L],forced vital capacity(FVC)[2.46 L,range:(2.12-3.08)L vs.1.95 L,range:(1.43-2.58)L],and forced expiratory volume in 1 second(FEV1)/FVC%[84.18%,range:(75.59-88.83)%vs.80.94%,range:(69.07-83.08)%],with significant differences from patients in the IPF group(Z=2.032,2.248,2.357,2.421,3.102,P=0.042,0.025,0.018,0.015,0.002).Positive correlations of DLCO were found with residual volume of the predicted(RV%pred),vital capacity of the predicted(VC%pred),alveolar ventilation of the predicted(VA%pred),total lung capacity of the predicted(TLC%pred),forced vital capacity of the predicted(FVC%pred),and percentage of forced expiratory volume in first second as predicted(FEV1%pred)in the IPF group(r=0.422,0.370,0.473,0.520,0.356,0.267,P=0.000,0.002,0.000,0.000,0.003,0.029),but not in the CPFE group.According to multivariate Logistic regression analysis,smoking(OR=5.421,95%CI:1.458-20.154,P=0.012)and allergies(OR=7.458,95%CI:1.795-30.979,P=0.006)were independent predictors of CPFE.Conclusions The eosinophil count and lung volume in elderly CPFE patients are higher than those in IPF patients,and the significant feature is the decrease of DLCO,which is not correlated with changes in lung ventilation parameters and lung volume.Smoking and allergies are risk factors for CPFE in the elderly.