【作者】 王玉洁；

【导师】 张放；

【作者基本信息】 中国医科大学 ， 呼吸病学， 2018， 硕士

【摘要】 目的:特发性肺纤维化(Idiopathic pulmonary fibrosis,IPF)是最常见的特发性间质性肺炎(Idiopathic interstitial pneumonia,IIP)和最常诊断的间质性肺病(Interstitial lung disease,ILD)之一,其原因不明,预后常常不好。近年来虽然有吡啡尼酮等药物来延缓进展,但仍有很多患者将进展至肺功能晚期甚至需要肺移植,因此准确预测IPF预后及早期肺移植转诊至关重要。目前针对IPF患者预后的预测因素尚不多,本次研究通过病例分析探讨高分辨率计算机断层扫描(High resolution computed tomography scan,HRCT)测量的肺/主动脉直径比率评估IPF患者生存期的准确性及其临床应用价值。方法:我们收集了2013年至2015年在中国医科大学附属第一医院门诊及病房就诊的所有IPF患者资料,通过严格的纳入排除标准筛选出需要的IPF患者病例。通过选定肺动脉分叉的HRCT层面,并测量肺动脉(Pulmonary artery,PA)和升主动脉直径(Ascending aorta,A)以及PA:A比率,随访并统计患者生存时间,利用单因素Kaplan-Meier检验分别进行肺动脉大小、PA:A及GAP指数分级、年龄、性别、FVC%pred、DLCO%pred的预后分析,进而使用Cox比例风险模型对多因素进行综合分析,评估各项指标对IPF患者总体生存期的影响。结果:纳入的118例IPF确诊患者中,筛选出88例有可用HRCT扫描的IPF患者,HRCT测量显示平均肺动脉直径和PA:A比分别为31.84±4.7mm和0.87±0.12。通过单因素Kaplan-Meier检验得出PA>31.84mm、PA:A>1、GAP指数分级越高,IPF患者预后越差,两者之间有统计学意义(Log Rank法检验统计量χ~2:4.856;7.160;6.909,p<0.05)。通过将PA:A、GAP指数分级纳入多因素Cox比例风险模型中进行分析,结果显示PA:A是预测IPF患者预后的危险因素,有显著的统计学意义(相对危险度HR值:4.766,p<0.05),GAP指数分级在多因素分析中无意义。结论:相对于PA:A≤1的IPF患者,PA:A>1时,生存期短,预后差,是影响IPF预后的主要因素,通过对肺部HRCT的检测可预测该疾病预后。更多还原

【Abstract】 Objective: Idiopathic pulmonary fibrosis(IPF)is one of the most common idiopathic interstitial pneumonia(IIP)and the most commonly diagnosed interstitial lung disease(ILD).The reason is unknown and the prognosis is often not good.Although drugs such as pirenidone have been used to delay progress in recent years,many patients will progress to the late stage of lung function and even require lung transplantation.Therefore,accurately predicting the prognosis of IPF and the referral of early lung transplantation are very important.There are not many predictors of the prognosis of IPF patients.This case study assesses the accuracy of high-resolution computed tomography scan(HRCT)measurements of lung/aortic diameter ratios to assess the survival of patients with IPF.And its clinical application value.Methods: We collected all IPF patient data from the outpatient and ward clinics of the First Affiliated Hospital of China Medical University from 2013 to 2015,and selected the required IPF patient cases through strict exclusion criteria.By selecting the HRCT level of pulmonary artery bifurcation,and measuring the pulmonary artery(PA)and ascending aorta diameter(A)and PA:A ratio,the survival time of patients was followed and the single factor Kaplan-Meier test was used.The prognostic analysis of pulmonary artery size,PA:A and GAP index classification,age,gender,FVC% pred,and DLCO% pred were performed.Then a multi-factor analysis was performed using the Cox proportional hazards model to assess the overall survival of patients with IPF.The impact of the period.Results: Among the 118 IPF confirmed patients included,88 IPF patients with HRCT scans were screened.HRCT measurements showed that the average pulmonary artery diameter and PA:A ratio were 31.84 mm and 0.87,respectively.The univariate Kaplan-Meier test showed that the higher the PA>31.84 mm,PA:A>1,and GAP index grades,the worse the prognosis of IPF patients.There was a statistically significant difference between them(Log Rank test statistic χ2:4.856.7.160;6.909,P<0.05).By analyzing the PA:A and GAP index classification into the multi-factor Cox proportional hazards model,the results showed that PA:A is a risk factor forpredicting the prognosis of patients with IPF,with significant statistical significance(relative risk HR: 4.766,P <0.05),GAP index classification is not meaningful in multivariate analysis.Conclusion: Compared with PA:A≤1 IPF patients,PA:A>1,short survival time,poorprognosis,is the main factor affecting the prognosis of IPF,through the detection of lung HRCT can predict the prognosis of the disease.更多还原