特发性肺纤维化预后相关因素的回顾性研究

目的探讨基线临床指标和肺生理状况对评估特发性肺纤维化(IPF)预后的意义。方法以2002年1月1日至2010年7月31日在南京大学医学院附属鼓楼医院确诊的84例IPF患者为研究对象,评估年龄、性别、吸烟史、糖皮质激素治疗、确诊前病程、体重指数、杵状指、氧合指数(PaO2/FiO2)、C反应蛋白(CRP)、血沉(ESR)、血清乳酸脱氢酶(LDH)、血白蛋白(ALB)等基线临床和肺功能指标对IPF患者预后的影响。采用单因素Cox比例风险回归模型评估各指标对患者死亡风险度的影响,采用Kaplan-Meier检验比较各组间生存率。结果 IPF患者确诊后中位生存期为34.7个月。氧合指数以及用力肺活量(FVC)、肺活量(VC)、肺总量(TLC)、一氧化碳弥散量(DLCO)的实测值占预计值百分比(%pred)均能影响IPF患者的死亡风险(HR值0.940～0.994,P均<0.01)。上述各指标的组间生存率比较均有统计学差异(Log-rank值5.288-23.405,P均<0.05)。此外,血清LDH升高组与正常组的组间生存率亦有显著差异(Log-rank值6.092,P=0.014)。结论基线氧合指数和肺功能各指标(FVC%pred、VC%pred、TLC%pred、DLCO%pred)可能对IPF患者的预后有指示作用。血清LDH升高与否亦可能与IPF生存有关联。

Retrospective Study on Prognostic Factors of Idiopathic Pulmonary Fibrosis

Objective To explore the prognostic significance of baseline clinical and pulmonary physiological variables on idiopathic pulmonary fibrosis(IPF).Methods Patients diagnosed with IPF according to 2011 ATS/ERS/JRS/ALAT statement were selected from Nanjing Drum Tower Hospital between January 1,2002 and July 31,2010.The baseline characteristics were abstracted,including age,gender,smoking history,corticosteroid,delay before diagnosis,body mass index,finger clubbing,oxygenation index(PaO 2/FiO2),C-reaction protein,erythrocyte sedimentation rate(ESR),serum lactate dehydrogenase(LDH),albumin,vital capacity(VC),forced vital capacity(FVC),total lung capacity(TLC),and singlebreath diffusing capacity of the lung for carbon monoxide(D L CO).The relationships between all factors and survival were examined with a univariate Cox proportional-hazard model.Kaplan-Meier method was used to assess the survival probabilities between groups with different baseline characteristics.Results Eighty-four patients were included in this study,with the median survival time of 34.7 months.PaO 2/FiO 2,FVC%pred,VC% pred,TLC% pred,and D L CO% pred showed significant associations with the mortality of IPF(hazard ratios 0.940-0.994,P<0.01).The Kaplan-Meier analyses for above variables also showed significant differences(P<0.05).Besides,the statistical difference of survival probability could be found between the patients with elevated serum LDH and those with normal LDH(27.0 months vs.43.1 months,P=0.014).Conclusions Baseline oxygenation and pulmonary function parameters may indicate the prognosis of IPF patients.Serum LDH may provide clinicians with additional prognostic information.