350例老年肺炎病例中伴发肺纤维化概率及关联因素分析

Probability and related factors of pulmonary fibrosis in 350 elderly patients

目的探究350例老年肺炎病例中伴发肺纤维化的概率及关联因素分析。方法选择2018年1月至2022年12月长治医学院附属和平医院接受诊断和治疗的老年患者,将符合标准的350例纳入研究。分析其临床资料、肺纤维化发生率,并分析两者之间的关系。结果350例患者年龄平均(63.51±5.74)岁;普通型219例,重症72例,危重症59例;入院时CT征象分别为:磨玻璃66例(18.86%)、铺路石征37例(10.57%)、实变73例(20.86%)、结节93例(26.57%)、煎蛋征20例(5.71%)、马赛克征61例(17.43%)。出院时病灶征象分别为:无病灶61例(17.43%)、维持原病灶征象207例(59.14%)、演变为其他征象82例(23.43%)。出院肺纤维化76例,发生率为21.71%。在年龄、治疗中病灶演变、出院时病灶征象和临床分期不同患者中,肺纤维化的发生率差异有统计学意义(均P<0.001)。肺纤维化与年龄(P=0.047)、出院时病灶征象(P=0.032)、临床分型(P=0.010)均呈正相关。其中出院时病灶呈铺路石征(P=0.014)、重症患者(P=0.013)伴纤维化的发生率更高。年龄增长(P=0.047)、入院时病灶范围广(P=0.042)、出院时病灶演变为其他征象(P=0.016)、临床分型为重症(P=0.008)或危重症(P=0.021)是影响老年肺炎患者发生肺纤维化的独立危险因素。结论老年肺炎患者肺纤维化发生率超20%,年龄增加、入院时病灶范围广、出院时病灶演变为其他征象、临床分型为重症或危重症是影响老年肺炎患者发生肺纤维化的独立危险因素。

Objective To explore the probability and associated factors of pulmonary fibrosis in 350 cases of elderly pneumonia.Methods Elderly patients who received diagnosis and treatment at Changzhi Medical College Affiliated Peace Hospital from January 2018 to December 2022 were selected,and 350 patients who met the criteria were included in the study.Analyze its clinical data,incidence of pulmonary fibrosis,and analyze the relationship between the two.Results The average age of 350 patients was(63.51±5.74)years old;219 cases were common type,72 cases were severe type,and 59 cases were critically ill.At admission,the CT signs were:ground glass in 66 cases(18.86%),paving stone in 37 cases(10.57%),consolidation in 73 cases(20.86%),nodules in 93 cases(26.57%),fried egg sign in 20 cases(5.71%),and mosaic sign in 61 cases(17.43%).At discharge,the lesion signs were as follows:61 cases(17.43%)had no lesions,207 cases(59.14%)maintained the original lesion signs,and 82 cases(23.43%)evolved into other signs.76 cases of pulmonary fibrosis were discharged,with an incidence rate of 21.71%.There were significant differences in the incidence of pulmonary fibrosis among patients with different ages,lesion evolution during treatment,lesion signs at discharge,and clinical stages(all P<0.001).Pulmonary fibrosis is positively correlated with age(P=0.047),lesion signs at discharge(P=0.032),and clinical classification(P=0.010).The incidence of lesions presenting as paving stones(P=0.014)and fibrosis in critically ill patients(P=0.013)at discharge is higher.Age increase(P=0.047),wide range of lesions at admission(P=0.042),evolution of lesions into other signs at discharge(P=0.016),and clinical classification as severe(P=0.008)or critically ill(P=0.021)are independent risk factors for the development of pulmonary fibrosis in elderly pneumonia patients.Conclusion The incidence of pulmonary fibrosis in elderly patients exceeds 20%.Increasing age,wide range of lesions upon admission,evolution of lesions into other signs upon discharge,and clinical classification as severe or critically ill are independent risk factors for the occurrence of pulmonary fibrosis in elderly pneumonia patients.