中国全科医学2016，Vol.19Issue(35)：4338-4345,8.DOI:10.3969/j.issn.1007-9572.2016.35.010
特发性肺纤维化患者临床和肺生理指标的变化及其与预后关联性的研究
Relevance Analysis of Changes in Clinical Indicators and Pulmonary Physiological Parameters and Prognosis of Idiopathic Pulmonary Fibrosis
摘要
Abstract
Objective To assess the relationship between the changing quantities at different times of clinical indicators,pulmonary physiological parameters and the prognosis of patients with idiopathic pulmonary fibrosis(IPF). Methods 126 patients with IPF,who received treatment in the First Hospital of China Medical University and the Affiliated Hospital of Logistics College of Chinese People′ s Armed Police Forces from January 2001 to August 2008,were selected as research objects. According to the follow - up time,the patients were followed up for 6 months(followed - up of 4 - 8 months,81 cases) and 12 months(followed - up of 9 - 15 months,52 cases) were analyzed. The relationship between the changing quantity of clinical indicators,pulmonary physiological parameters〔 dyspnea score,forced expiratory volume in first second( FEV1 ), forced vital capacity( FVC),total lung volume( TLC),residual volume( RV),diffusing capacity of carbon monoxide (DLCO),oxygen partial pressure( PaO2 ),partial pressure of carbon dioxide( PaCO2 ),oxygen saturation( SaO2 ) and alveolar - arterial partial pressure of oxygen difference(PA-a O2 )〕,compared with underlying variables(underlying variables -variables within follow - up for 6 months;underlying variables - variables within follow - up for 12 months),changing ratio (changing quantity/ underlying variables) and the prognosis of the IPF patients was analyzed. At the same time,taking the changing ratio as the grouping standard,the patients who were followed up for 6 months and 12 months in this study were respectively divided into improvement group,stable group and worsening group. Log-rank method was used to compare the differences in between - group survival rates of various clinical and pulmonary physiological parameters at the 6th month and the 12th month. The prognostic factors of IPF patients were analyzed by Cox proportional hazards regression. Results 52 patients had a follow - up of 13 to 84 months,and the median survival time was 51 months〔95% CI(22,56)〕. The results of univariate Cox proportional hazards regression analysis showed as follows:the changing value and ratio of dyspnea scores and the FEV1 , FVC,TLC,DLCO,PaO2 ,SaO2 ,PA-a O2 at the 6th month and the 12th month were the influencing factors of IPF patients′prognosis(P < 0. 05). There were significant differences of survival rate of improvement group,stable group and worsening group of dyspnea scores,FVC,DLCO,PaO2 ,SaO2 and PA-a O2 at the 6th and the 12th month,and TLC at the 12th month(P< 0. 05). Multivariate Cox proportional hazards regression analysis showed that the changing ratio of dyspnea scores〔 HR= 1. 131,95% CI(1. 044,1. 311),P = 0. 027〕,FVC〔HR = 0. 899,95% CI(0. 709,0. 945),P < 0. 001〕and PaO2〔HR = 0. 957,95% CI(0. 890,0. 987),P = 0. 034〕were the influencing factors of the prognosis of IPF patients at the 6th month;the changing ratio of FVC〔 HR = 0. 838,95% CI(0. 811,0. 910),P < 0. 001〕,TLC〔 HR = 0. 962,95% CI (0. 890,0. 987),P = 0. 048〕and DLCO〔HR = 0. 932,95% CI(0. 875,0. 967),P < 0. 001〕were the influencing factors of the prognosis of IPF patients at the 12th month. Conclusion Clinical indicators and pulmonary physiological parameters are easy to determine with good reproducibility,which can be the monitoring indicators of IPF patients′ prognosis. The changing ratio of the parameters at 6th month and 12th month can better predict the prognosis of patients with IPF.关键词
特发性肺纤维化/预后/比例危险度模型/肺活量Key words
Idiopathic pulmonary fibrosis/Prognosis/Proportional hazards models/Vital capacity分类
医药卫生引用本文复制引用
彭守春,李学任..特发性肺纤维化患者临床和肺生理指标的变化及其与预后关联性的研究[J].中国全科医学,2016,19(35):4338-4345,8.基金项目
武警后勤学院附属医院种子基金重点项目 （）
