肺间质纤维化34例临床分析

目的 研究慢性阻塞性肺疾病（COPD）合并肺间质纤维化（PIF）的临床特点并探讨其临床意义。方法对34例COPD合并PIF患者的病程、症状、体征、肺功能和血气分析、胸部X线片、胸部高分辨率CT（HRCT）进行回顾性分析,并与单纯COPD患者进行比较。结果 1与单纯COPD相比较,COPD合并PIF患者病程较长,临床多表现为混合型呼吸困难并进行性加重,肺部听诊可闻及Velcro啰音伴有杵状指（趾）（P〈0.01）;2合并PIF组混合性通气功能障碍发生率及肺弥散功能降低显著大于单纯COPD组,单纯COPD组阻塞性通气功能障碍发生率显著高于合并PIF组;3合并PIF组PaO2降低和PaCO2升高显著高于单纯COPD组;4影像学显示合并PIF组胸部X线片显示弥漫点状、结节状影、网格状、毛玻璃状和蜂窝状影较多,HRCT显示以支气管管壁增厚,支气管血管束增粗扭曲、变形、小叶间隔增厚为主。结论 COPD合并PIF患者由于双重的病理损害造成肺通气功能、弥散功能严重障碍和严重低氧血症,并具有独特的临床与影像学特征,影响患者预后,肺功能及HRCT可为临床提供重要的诊断依据。

Clinical analysis of treatment of chronic obstructive pulmonary disease complicated with pulmonary interstitial fibrosis

Objective To explore the clinical characteristics and significance of the chronic obstructive pulmonary disease（COPD） complicated with pulmonary interstitial fibrosis（PIF）.Methods The data of clinical symptoms,signs,pulmonary function and arterial blood gas analysis,chest X-ray,high resolution CT（HRCT） of 34 cases complicated with PIF were retrospectively analyzed,and compared with COPD patients.Results 1compared with simple COPD,COPD patient＇s duration were longer than the patients with PIF,the clinical features of patients with COPD and PIF were mixed type and progressive dyspnea,lung auscultation may hear Velcro rales accompanied by clubbed-finger（toe）（P〈 0.01）;2The mixed ventilatory dysfunction and the incidence of pulmonary diffusion function of the patients with PIF were decreased significantly than simple COPD group,simple COPD group obstructive ventilatory dysfunction rate was significantly higher than that of combined PIF group;3the group with PIF PaO2 decreased and PaCO2 increased significantly higher than that of pure COPD group;4the imaging display of the patients with PIF group chest X-ray showed diffuse point shape,nodular shadow,grid,frosted glass and honeycomb shadow more,HRCT showed bronchial wall thickening,the broncho vascular bundle twisting thickening,deformation,interlobular septal thickening.Conclusion The patients with COPD complicated with PIF damage ventilation and diffusion function of pulmonary,which can lead to severe hypoxemia,and has the unique characteristics of clinic and image,affects the prognosis of patients,pulmonary function and HRCT can provide important evidence in clinical diangosis.