肺纤维化合并肺气肿综合征肺功能及与高分辨率CT定量相关性分析

Correlation of pulmonary function and high resolution CT quantitativity in combined pulmonary fibrosis and emphysema

目的分析肺纤维化合并肺气肿(CPFE)综合征患者肺功能及与高分辨率CT(HRCT)定量相关性。方法本研究为病例对照研究,采用非随机对照的方法收集2011年10月至2021年10月于兰州大学第一医院住院治疗的CPFE综合征患者239例和同期收治的特发性肺纤维化(IPF)患者294例及肺气肿患者287例,根据肺部纤维化程度<5%、≥5%且<10%、≥10%将CPFE综合征患者分为轻度、中度、重度纤维化亚组;又根据肺气肿程度≥10%且<20%、≥20%且<30%、≥30%,将CPFE组患者分为轻度、中度、重度肺气肿亚组。分别比较CPFE组、IPF组、肺气肿组之间;轻度、中度、重度纤维化亚组之间;轻度、中度、重度肺气肿亚组之间的肺功能指标,分析CPFE组肺功能指标与HRCT所示肺纤维化、肺气肿及实质肺破坏的总体严重程度的相关性。结果CPFE组肺动脉收缩压高于IPF组和肺气肿组(P值均<0.05)。CPFE组RV%pred、TLC%pred、RV/TLC%pred低于肺气肿组(P值均<0.05),CPFE组FEV_(1)%pred、FEV_(1)/FVC高于肺气肿组,低于IPF组(P值均<0.05)。CPFE组D_(L)CO、D_(L)CO%pred、D_(L)CO/VA、D_(L)CO/VA%pred低于IPF组和肺气肿组(P值均<0.05)。CPFE不同纤维化程度肺功能比较,重度纤维化组VC%pred、TLC%pred、FVC%pred、D_(L)CO、D_(L)CO%pred低于中度纤维化组(P值均<0.05),RV%pred低于轻、中度纤维化组(P值均<0.05),FEV_(1)/FVC高于轻、中度纤维化组(P值均<0.05),CPFE不同肺气肿程度肺功能比较,重度肺气肿组FEV_(1)%pred、FEV_(1)/FVC低于轻、中度肺气肿组(P值均<0.05),D_(L)CO、D_(L)CO%pred、D_(L)CO/VA、D_(L)CO/VA%pred低于轻度肺气肿组(P值均<0.05),CPFE综合征患者HRCT所示肺纤维化程度与VC%pred、RV%pred、TLC%pred、FVC%pred、FEV_(1)/FVC、D_(L)CO、D_(L)CO%pred、D_(L)CO/VA、D_(L)CO/VA%pred存在相关性(r值分别为-0.30、-0.34、-0.42、-0.29、0.35、-0.26、-0.26、-0.13、-0.14,P值均<0.05),HRCT所示肺气肿程度与FEV_(1)%pred、FEV_(1)/FVC、D_(L)CO、D_(L)CO%pred、D_(L)CO/VA、D_(L)CO/VA%pred存在相关性(r值分别为-0.32、-0.43、-0.26、-0.26、-0.34、-0.33,P值均<0.05),HRCT所示实质肺破坏的总体严重程度与VC%pred、FVC%pred、FEV_(1)%pred、FEV_(1)/FVC、D_(L)CO、D_(L)CO%pred、D_(L)CO/VA、D_(L)CO/VA%pred存在负相关(r值分别为-0.17、-0.17、-0.35、-0.36、-0.37、-0.37、-0.41、-0.41,P值均<0.05)。结论CPFE综合征好发于老年男性吸烟者,易合并肺动脉高压,弥散功能显著下降,胸部HRCT定量测量可一定程度评估弥散功能。

Objective To analyze the correlation of pulmonary function and high-resolution CT(HRCT)in patients with combined pulmonary fibrosis and emphysema(CPFE).Methods This is a case control study.From October 2011 to October 2021,a total of 239 CPFE patients and 294 idiopathic pulmonary fibrosis(IPF)patients and 287 emphysema patients who visited the First Hospital of Lanzhou University were enrolled and divided into three groups by non-randomized control method:CPFE group,IPF group,emphysema group.The patients in CPFE group were assigned into mild,moderate and severe fibrosis subgroups(ratio of high attenuation areas,[HAA%]<5%,≥5%and<10%,≥10%),meantime,these patients also into mild,moderate and severe emphysema subgroups(emphysema score≥10%and<20%,≥20%and<30%,≥30%).The in-group pulmonary function indices were compared,and the correlation between the above indicators and the severity of pulmonary fibrosis,emphysema and parenchymal destruction in HRCT dispaly in CPFE group was analyzed.Results The ratio of pulmonary artery systolic pressure in CPFE group was higher than that in IPF group and emphysema group(all P<0.05).The percentage of predicted values of residual volume(RV%pred),total lung capacity(TLC%pred)and ratio of RV to TLC(RV/TLC%pred)were decreased in CPFE group than in emphysema group(all P<0.05).The percentage of predicted values of forced expiratory volume in first second(FEV_(1)%pred)and the ratio of FEV_(1) to forced vital capacity(FEV_(1)/FVC)in CPFE group were higher than those in emphysema group,but lower than IPF group(all P<0.05).The diffusion capacity for carbon monoxide(D_(L)CO),the percentage of predicted values of D_(L)CO(D_(L)CO%pred),diffusion capacity for carbon monoxide per alveolar volume(D_(L)CO/VA)and the percentage of predicted values of D_(L)CO/VA(D_(L)CO/VA%pred)were lower in CPFE group compared with IPF group and emphysema group(all P<0.05).Compared pulmonary function among CPFE fibrosis subgroups,the percentage of predicted values of vital capacity(VC%pred),TLC%pred,FVC%pred,D_(L)CO,D_(L)CO%pred in severe fibrosis group were lower than those in moderate fibrosis group(all P<0.05),RV%pred was lower than that in mild and moderate fibrosis group(all P<0.05),FEV_(1)/FVC was higher than that in mild and moderate fibrosis group(all P<0.05).Compared pulmonary function among CPFE emphysema subgroups,FEV_(1)%pred and FEV_(1)/FVC in severe emphysema group were lower than those in mild and moderate emphysema group(all P<0.05),and D_(L)CO,D_(L)CO%pred,D_(L)CO/VA and D_(L)CO/VA%pred were lower than those in mild emphysema group(all P<0.05).The degree of pulmonary fibrosis in CPFE patients measured by HRCT was associated with VC%pred,RV%pred,TLC%pred,FVC%pred,FEV_(1)/FVC,D_(L)CO,D_(L)CO%pred,D_(L)CO/VA,D_(L)CO/VA%pred(r values were-0.30,-0.34,-0.42,-0.29,0.35,-0.26,-0.26,-0.13,-0.14,respectively,all P<0.05).The correlation between the degree of emphysema measured by HRCT and FEV_(1)%pred,FEV_(1)/FVC,D_(L)CO,D_(L)CO%pred,D_(L)CO/VA,D_(L)CO/VA%pred was found(r values were-0.32,-0.43,-0.26,-0.26,-0.34,-0.33,respectively,all P<0.05).The overall severity of parenchymal lung destruction measured by HRCT was negatively correlated with VC%pred,FVC%pred,FEV_(1)%pred,FEV_(1)/FVC,D_(L)CO,D_(L)CO%pred,D_(L)CO/VA,D_(L)CO/VA%pred(r values were-0.17,-0.17,-0.35,-0.36,-0.37,-0.37,-0.41,-0.41,respectively,all P<0.05).Conclusions CPFE is more likely to occur in elderly male smokers with pulmonary hypertension and significantly decreased diffusion function.Quantitative measurement of chest HRCT can evaluate the diffusion function to a certain extent.