肺纤维化合并肺气肿患者的肺功能特征

目的 了解肺纤维化合并肺气肿（combined pulmonary fibrosis and emphysema,CPFE）患者肺功能特点,及是否能通过肺功能将CPFE、单纯肺气肿、未合并肺气肿的特发性肺纤维化（idiopathic pulmonary fibrosis,IPF）进行区分.方法 回顾性分析了48例CPFE患者利用肺量计及脉冲振荡法测量的肺功能参数,并与单纯肺气肿患者（50例）、未合并肺气肿的IPF患者（46例）的肺功能进行了比较.结果 肺量计参数显示：CPFE组肺总量（TLC）％ pred正常[（86.9±17.8）％],而未合并肺气肿的IPF组TLC％ pred明显降低[（70.4±17.0）％],CPFE组的FEV1/FVC大致正常[（72.0±9.4）％],而单纯肺气肿组明显降低[（56.5±14.4）％],CPFE组、单纯肺气肿组及未合并肺气肿的IPF组的弥散功能均降低,分别为（57.2±17.3）％、（62.8±25.7）％、（66.9±21.5）％.脉冲振荡法测量的参数显示：CPFE组与未合并肺气肿的IPF组总气道阻力（R5）正常,而单纯肺气肿组明显增高[（161.3±69.0）％],虽然CPFE组、单纯肺气肿组及未合并肺气肿的IPF组外周气道阻力（R5-R20）均增加,但单纯肺气肿组较CPFE组和未合并肺气肿的IPF组增加更为明显（P=0.006,P=0.013）,三组X5轻度减低,单纯肺气肿组较CPFE组和IPF组减低更为明显（P=0.004,P=0.047）.相关分析显示：CPFE组、单纯肺气肿组R5-R20和RV/TLC呈正相关（r=0.44,P=0.01;r=0.66,P=0.01）;CPFE组、单纯肺气肿组K与RV/TLC呈负相关（r=-0.51,P=0.01; r=-0.66,P=0.01）,未合并肺气肿的IPF组TLC％ pred与R5-R20和X5有相关性（r=-0.50,P=0.01; r=0.6,P=0.01）.结论 CPFE的肺功能特点为肺容积正常,通气功能正常,弥散功能明显降低,总气道阻力及中心气道阻力正常,周边气道阻力增加和弹性阻力增高,肺的顺应性降低.

Pulmonary function features of combined pulmonary fibrosis and emphysema

Objective To evaluate the pulmonary function characteristics of patients with combined pulmonary fibrosis and emphysema （CPFE）,and to examine whether distinguishing CPFE,emphysemaalone （EA）,and pulmonary fibrosis （IPF） without emphysema by the pulmonary function method.Methods The pulmonary function parameters of 48 patients with CPFE,50 cases of EA,and 46 cases of IPF without emphysema were analyzed and compared by conventional methods of lung function testing and impulse oscillometry system.Results Total lung capacity （TLC）%0 pred was normal in CPFE group [（86.9±17.8） %].TLC%pred was decreased in IPF without emphysema group [（70.4±17.0）%].The forced expiratory volume in one second （FEV1）/forced vital capacity （FVC） in CPFE group was normal [（72.0± 9.4）%].FEV1/FVC decreased in EA group [（56.5± 14.4）%].Diffusion capacity was lower in CPFEgroup [（57.2± 17.3）%],EA group [（62.8±25.7）%],and IPF without emphysema group [（66.9± 21.5）%],respectively.R5 % pred in CPFE group and IPF without emphysema group was normal by impulse oscillometry system.However,R5 % pred was significantly elevated in EA group [（161.3 ±69.0） %].R5-R20 increased in the three groups.Compared with CPFE group and IPF without emphysema group,R5 R20 increased significantly in EA group （P =0.006,P =0.013）.In addition,X5 reduced in the three groups.Compared with CPFE group and IPF without emphysema group,X5 decreased significantly in EA group （P 0.004,P =0.047）.In CPFE group and EA group,there was positive correlation between R5-R20 and RV/TLC （r =0.44,P =0.01; r =0.66,P =0.01）.In CPFE group and EA group,there was negative correlation betweenX5 and RV/TLC （r =0.51,P =0.01; r =0.66,P =0.01）.In IPF without emphysema group,there was correlation between TLC% pred and R5-R20 and X.5 （r =-0.50,P =0.01; r =0.6,P =0.01）.Conclusions Pulmonary function features of CPFE show that lung volume,ventilation function,total airway resistance,and central airway resistance are normal,diffu