间质性肺疾病并发气胸、纵隔气肿的临床特点分析

Analysis of the clinical characteristics of interstitial lung disease complicated by pneumothorax and hystitial diastinum

目的 分析间质性肺疾病(interstitial lung disease, ILD)并发气胸、纵隔气肿患者的临床特点。方法 选择2011年11月至2022年8月我院收治的ILD并发气胸、纵隔气肿患者36例为对象,对ILD临床特点及转归进行分析。结果 36例患者中,气胸20例,纵隔气肿16例,两类患者中以特发性肺纤维化(idiopathic fibrosis of the lung, IPF)占比例最高,分别为8例(40.00%)、4例(25.00%),其他ILD类型包括:特发性胸膜肺弹力纤维增生症(idiopathic pleuroparenchymal fibroelastosis, iPPFE)、特发性非特异性间质性肺炎(idiopathic non-specific interstitial pneumonia, iNSIP)、自身免疫特征的间质性肺炎(interstitial pneumonia with autoimmune features, IPAF)、皮肌炎(dermatomyositis interstitial lung disease, DM-ILD)、类风湿性(rheumatoid interstitial lung disease, RA-ILD)、显微镜下多血管炎(microscopic polyvasculitis interstitial lung disease, MPA-ILD)、肺泡蛋白质沉积症(pulmonary alveolar proteinosis, PAP)、化疗药相关、隐源性机化性肺炎(cryptogenic organizing pneumonia, COP)。影像学类型以普通型(usual interstitial pneumonia, UIP)及NSIP为主要表现。此类人群存在咳嗽症状,可同时合并肺气肿、肺大泡、肺源性心脏病、胸腔积液、感染等。部分患者同时存在ILD加重或发生ILD急性加重期(acute exacerbation of ILD, AE-ILD)。对比转归为好转的患者,死亡患者中,出现ILD加重,发生AE-ILD,住院期间应用呼吸机治疗,发病前应用糖皮质激素治疗,入院时氧合指数相对较低的患者比例较高(P<0.05),其中发生AE-ILD的气胸及纵隔气肿患者死亡。结论 气胸及纵隔气肿是ILD的并发症之一,影响ILD患者的预后,应积极预防其发生,当ILD患者出现呼吸困难加重、胸痛、氧合下降等情况时,需积极完善相关检查,警惕气胸及纵隔气肿的发生。

Objective To analyze the clinical characteristics of patients with interstitial lung disease(ILD)complicated with pneumothorax and mediastinal emphysema.Methods The clinical data of 36 ILD patients with pneumothorax and mediastinal emphysema diagnosed and treated in the respiratory department of our hospital from November,2011 to August,2022 were retrospectively analyzed,the clinical characteristics of this population were described,and the outcome was analyzed.Results There were 20 patients with pneumothorax and 16 patients with mediastinal emphysema.IPF accounted for the highest proportion of the two types of patients,8 cases(40.00%)and 4 cases(25.00%),respectively.Other ILD types include:idiopathic pleuroparenchymal fibroelastosis(iPPFE),idiopathic non-specific interstitial pneumonia(iNSIP),interstitial pneumonia with autoimmune features(IPAF),dermatomyositis interstitial lung disease(DM-ILD),rheumatoid interstitial lung disease(RA-ILD),microscopic polyvasculitis interstitial lung disease(MPA-ILD),pulmonary alveolar proteinosis(PAP),chemotherapy related interstitial lung disease,cryptogenic organizing pneumonia(COP).usual interstitial pneumonia(UIP)and NSIP were the main imaging types.The patients had cough symptoms.They were complicated with emphysema,pulmonary bullae,pulmonary heart disease,pleural effusion,infection,etc.Some patients also had ILD exacerbation or acute exacerbation of ILD(AE-ILD).Among the patients who died,the proportion of patients with ILD exacerbation,AE-ILD,ventilator treatment during hospitalization and glucocorticoid treatment before onset was higher(P<0.05),and the proportion of patients with pneumothorax and mediastinal emphysema who developed AE-ILD was higher(P<0.05).Conclusion Pneumothorax and mediastinal emphysema are both of the complications of ILD.They can affect the prognosis of patients with ILD,and should be actively prevented.When patients with ILD have increased dyspnea,chest pain,decreased oxygenation and other conditions,it is necessary to actively improve the relevant examination,and be alert to the occurrence of pneumothorax and mediastinal emphysema.