支气管肺泡灌洗液细胞类型与特发性肺纤维化预后的关联性研究

目的 探讨临床指标、肺功能和BALF中细胞类型与特发性肺纤维化(IPF)患者预后的关系.方法 经临床诊断的43例IPF患者进行肺功能和支气管肺泡灌洗检查.采用Kaplan-Meier检验比较组间生存率,采用Cox比例风险回归方法评价各参数的死亡风险度.结果 IPF患者存在限制性通气功能障碍和弥散功能障碍,FVC占预计值%、肺总量占预计值%和DLCO占预计值%分别为(61±18)%、(54±13)%和(48±14)%.在平均随访30.7个月内,IPF患者诊断后的中位生存期为28.5个月.糖皮质激素和(或)细胞毒类药物治疗不能改变IPF患者的预后.单因素Cox比例风险回归分析结果表明,FVC占预计值%、肺总量占预计值%、DLCO占预计值%、中性粒细胞和嗜酸粒细胞比例是影响IPF患者预后的因素,多因素Cox比例风险回归分析结果表明仅DLCO占预计值%和中性粒细胞比例是影响IPF患者预后的主要因素.结论 IPF患者主要为老年男性,存在限制性通气功能障碍和弥散功能障碍.糖皮质激素和(或)细胞毒类药物不能改变IPF患者的预后.DLCO占预计值%和中性粒细胞比例是影响IPF患者预后的主要因素,其中DLCO占预计值%和IPF患者的预后呈负相关,中性粒细胞比例和IPF患者的预后呈正相关.

Cell profiles of bronchoalveolar lavage fluid as prognostic indicators of idiopathic pulmonary fibrosis

OBJECTIVE: To determine whether clinical and physiologic variables and bronchoalveolar lavage fluid (BALF) cell profiles affect the survival of patients with idiopathic pulmonary fibrosis (IPF). METHODS: There were 43 patients with clinically diagnosed IPF in the study. The Kaplan-Meier method and the Log-rank test were used to estimate the survival in the two groups and Cox proportional hazard regression was used to evaluate the Harzard Ratio in the IPF patients. RESULTS: The IPF patients presented with restrictive ventilatory disorders FVC%: (61 +/- 18)%, TLC%: (54 +/- 13)%] and gas exchange impairment D(L)CO%: (48 +/- 14)%]. The mean follow-up time was 30.7 months, and the median survival of IPF patients was 28.5 months after diagnosis. FVC ( Wald = 6.71, P < 0.01), TLC ( Wald = 12.37, P < 0.01) , D(L)CO ( Wald = 22.78, P < 0.01), neutrophil ( Wald = 16.26, P < 0.01) and eosinophil ( Wald = 7.73, P < 0.01) percentages were prognostic variables in the univariate Cox proportional hazard regression, and only D(L)CO (HR = 0.93, Wald = 15.77, P < 0.01) and the neutrophil percentage (HR = 1.07, Wald = 6.83, P < 0.01) were prognostic variables for IPF patients in the multivariate Cox proportional hazard regression. CONCLUSIONS: The IPF patients were predominantly old males and presented with restrictive ventilatory disorders and gas exchange impairment. Glucocorticoids and/or cytotoxic drugs could not improve the prognosis for the IPF patients. DLCO and BALF neutrophil percentage were prognostic variables, and DLCO was negatively correlated with the prognosis while the neutrophil percentage was positively correlated with the prognosis in the IPF patients.