肺纤维化合并肺气肿综合征患者的临床表现及加重危险因素分析

Clinical manifestations of patients with combined pulmonary fibrosis and emphysema and the risk factors for exacerbation

目的分析肺纤维化合并肺气肿综合征(CPFE)患者的临床表现及其呼吸困难加重的危险因素。方法回顾性分析榆林市第一医院2017年1月至2021年4月期间收治的68例CPFE患者的临床资料,按改良版英国医学研究会呼吸困难量表(mMRC)将患者分为轻度组37例和重度组31例,采用Logistic回归分析导致CPFE患者呼吸困难加重的危险因素。结果CPFE患者的年龄均较高[(66.42±4.93)岁],男性患者较多(91.18%),吸烟患者占比较高(76.47%),多伴有咳嗽(91.18%)、胸闷(73.53%)、气促(80.88%)、Velcro啰音(86.76%)等。单因素分析结果显示,轻度组和重度组患者的吸烟史(64.86%vs 90.32%)、粉尘暴露史(2.70%vs 19.35%)以及FVC%pred[(83.24±8.13)%vs(79.36±7.44)%]、FEV1%pred[(79.61±8.95)%vs(75.35±8.46)%]、FEV1/FVC%pred[(84.63±10.25)%vs(79.31±10.16)%]、DLCO%pred[(41.55±8.64)%vs(33.97±7.38)%]比较差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,吸烟史、粉尘暴露史以及DLCO水平是CPFE患者呼吸困难的独立危险因素(P<0.05)。结论CPFE患者多好发于老年男性,吸烟及粉尘暴露可能会导致CPFE发生风险增加,临床上治疗CPFE患者时需要注意检测患者DLCO水平,同时要控制患者吸烟和粉尘暴露等各种危险因素。

Objective To analyze the clinical manifestations of patients with combined pulmonary fibrosis and emphysema(CPFE),and the risk factors for exacerbation of dyspnea.Methods The clinical data of 68 patients with CPFE admitted to the First Hospital of Yulin City between January 2017 and April 2021 were retrospectively analyzed.According to the modified Medical Research Council(mMRC)dyspnea score,the patients were divided into mild group(37 cases)and severe group(31 cases).Logistic regression analysis was conducted to screen the risk factors for exacerbation of dyspnea in patients with CPFE.Results CPFE patients were relatively old in age[with an average age of(66.42±4.93)years],and were mostly male(91.18%).The often had smoking habits(76.47%),and were mostly accompanied by cough(91.18%),chest tightness(73.53%),shortness of breath(80.88%),Velcro rales(86.76%).Univariate analysis found that there were significant difference between the two groups in the following indicators(P<0.05):smoking history,64.86%vs 90.32%;history of dust exposure,2.70%vs 19.35%;percentage of forced vital capacity in the predicted value(FVC%pred),(83.24±8.13)%vs(79.36±7.44)%;percentage of forced expiratory volume in the first second in the predicted value(FEV1%pred),(79.61±8.95)%vs(75.35±8.46)%;FEV1/FVC%pred,(84.63±10.25)%vs(79.31±10.16)%;and diffusion capacity for carbon monoxide as percentage of predicted(DLCO%pred),(41.55±8.64)%vs(33.97±7.38)%.Multivariate logistic regression analysis showed that smoking history,history of dust exposure,and DL-CO were independent risk factors for dyspnea in patients with CPFE(P<0.05).Conclusion CPFE mainly occurs in el-derly males.Smoking and dust exposure may increase the risk of CPFE.In clinical treatment,attention should be paid to the detection of DL,and risk factors such as smoking and dust exposure should be controlled.