临床和肺生理指标与特发性肺纤维化预后的相关性研究

目的 探讨临床指标、肺功能和动脉血气指标与特发性肺纤维化(IPF)患者预后的关系.方法 经临床诊断的49例IPF患者行呼吸困难评分、肺功能和动脉血气检测.采用Kaplan-Meier检验比较组间生存率,采用Cox比例风险回归评价各指标的死亡风险度.结果 在平均随访31个月内,IPF患者诊断后的中位生存期为25.7个月.糖皮质激素和(或)细胞毒类药物不能改变IPF患者的预后.单因素Cox比例风险回归分析显示,呼吸困难评分、肺泡动脉血氧分压差(PA-aO2)、用力肺活量占预计值百分比(FVC%pre)、肺总量占预计值百分比(TLC%pre)和一氧化碳弥散量占预计值百分比(DLCO%pre)是影响IPF患者预后的因素(P＜0.05),多因素Cox比例风险回归分析结果表明仅TLC%preHR=0.98,95%CI(0.95,0.99),Wald值=4.16,P=0.04]和DLCO%preHR=0.97,95%CI(0.94,0.99),Wald值=4.35,P=0.047是影响lPF患者预后的主要因素.结论 糖皮质激素和(或)细胞毒类药物不能改变IPF患者的预后.TLC%pre和DLCO%pre是影响肼患者预后的主要因素,与IPF患者预后呈正相关.

Correlation between Clinical and Pulmonary Physiological Parameters and Prognosis of Idiopathic Pulmonary Fibrosis

Objective To investigate the relationship between the clinical,pulmonary physiological and arterial gas analysis parameters and the prognosis of idiopathic pulmonary fibrosis (IPF).Methods Forty-nine patients with IPF according to clinical diagnosis underwent dyspnea score,pulmonary function tests and arterial blood gas test.The Kaplan-Meier test was used to estimate the survival in the two groups,and Cox proportional hazard regression was taken to evaluate Hazard Ratio in the IPF patients.Results In an average follow-up period of 31 months,the median survival period of IPF patients was 25.7 months after diagnosis.Glucocorticoid and/or cytotoxic drug could not change prognosis of IPF patients.The univariate Cox proportional hazard regression showed dyspnea score,PA-aO2,FVC% pre,TLC% pre and DLCO% pre were the influencing factors to the prognosis of IPF patients.The multivariate Cox proportional hazard regression showed only TLC% pre was major influencing factor to the prognosis of IPF patients.Conclusion Glucocorticoid and/or cytotoxic drug could not change prognosis in the IPF patients.TLC% pre and DLCO% pre are the prognostic variables for IPF patients and positively correlated to the prognosis of IPF patients.