通过初诊临床指标预测特发性肺纤维化患者的死亡风险

发布时间：2018-03-01 04:42

本文关键词： 特发性肺纤维化初诊临床指标死亡风险比　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:特发性肺纤维化是慢性进展性纤维化的间质性肺炎的一种特殊类型,其病因不明,预后差,目前临床上的治疗目标多以稳定病情和减缓疾病进展为主。近些年来,在全世界肺间质疾病的研究者们的共同努力下,涌现了大量关于IPF的临床研究,基因多态性,血浆标志物,动态临床指标以及初诊临床指标等手段均被用于预测IPF的预后。比起前三者,初诊临床指标不需要特殊的检测手段,且方便、快捷。鉴于此,本文重点选取了 IPF患者初诊时即可快速获得的4类(年龄、性别、身高体重指数,呼吸症状,肺功能,影像学)相关指标进行荟萃分析,评估这些指标对IPF患者死亡风险的预测价值。方法:通过在网络数据库(包括Pubmed数据库,Embase数据库,维普数据库,万方数据库)中检索相关文献,最终纳入32篇相关研究,并汇总纳入文献中所提供的总体死亡风险比(HR)值及其相应的95%置信区间进行荟萃分析。结果:10项观察指标中9项均具有统计学差异,结果以HR及其95%置信区间表示,分别为:年龄(HR=1.03,95%置信区间1.01-1.05,p=0.002)、身高体重指数(HR=0.96,95%置信区间0.94-0.98,p0.0001)、肺活量占预计值百分比(HR=0.98,95%置信区间0.97-0.98,p0.00001)、一氧化碳弥散量占预计值百分比(HR=0.98,95%置信区间0.96-0.99,P0.0001)、呼吸困难评分量表(HR=1.63,95%置信区间1.20-2.21,p=0.002)、肺气肿(HR=1.34,95%置信区间 1.02-1.76,p=0.04)、蜂窝影(HR=1.06,95%置信区间1.01-1.11,p=0.02)、肺纤维化程度评分(HR=1.27,95%置信区间 1.01-1.58,p=0.04)、肺动脉高压(HR=3.21,95%置信区间 1.67-6.18,p=0.005),而在性别组,男性相对于女性未发现显著差异(HR=1.22,95%置信区间为 1.00-1.50,p=0.05)。结论:在这篇文章中,我们通过荟萃分析手段,证明了特发性肺纤维化患者的初诊临床指标(包括年龄、身高体重指数、肺功能、症状、影像学表现)对于其疾病死亡风险的预测价值。同时,我们认为设计基于上述结果的多维度的评分系统或有助于预测特发性肺纤维化患者的死亡风险和生存期。
[Abstract]:Background: idiopathic pulmonary fibrosis is a special type of interstitial pneumonia with chronic progressive fibrosis. Its etiology is unknown and its prognosis is poor. With the concerted efforts of researchers in pulmonary interstitial diseases around the world, a large number of clinical studies, gene polymorphisms, plasma markers, have emerged on IPF. Dynamic clinical indicators and first-visit clinical indicators are used to predict the prognosis of IPF. Compared with the first three, the first visit clinical indicators do not need special means of detection, and are convenient and fast. In this paper, we selected four kinds of indexes (age, sex, height and body mass index, respiratory symptoms, lung function, imaging) that can be obtained quickly at the first visit of IPF patients for meta-analysis. Methods: to evaluate the predictive value of these indicators to the death risk of IPF patients. Methods: by retrieving the relevant literature in the network database (including Pubmed database Embase database, Weip database, Wanfang database), 32 related studies were included. The total death risk ratio (HRR) and its corresponding confidence interval (95%) provided in the literature were collected for meta-analysis. Results there were statistical differences in 9 out of 10 observed indexes, and the results were expressed as HR and its 95% confidence interval. The results were as follows: age scale 1.0395% confidence interval 1.01-1.05p0.002, height and body mass index 0.9695% confidence interval 0.94-0.98p0.0001g, lung capacity as percentage of predicted value 0.97-0.98p0.00001, carbon monoxide dispersion as percentage of predicted value 0.96895% confidence interval 0.96-0.9995% confidence interval 0.96-0.99P 0.0001g, respiratory dyspnea scale 1.6395%, HR0.9895% confidence interval 0.9895%, HR0.9895% confidence interval 0.96-0.99P0.0001a, respiratory dyspnea score scale 1.6395%. The confidence interval was 1.02-1.76p0. 04% for emphysema, 1.01-1.11p0. 02% for honeycomb, 1.2795% for pulmonary fibrosis, 1.01-1.58p0. 04 for pulmonary hypertension, and 1.67-6.18p0. 004 for pulmonary hypertension. There was no significant difference between male and female. The confidence interval of HRN 1.22 ~ 95% was 1.00-1.50 p0.05.Conclusion: in this article, we proved that the primary clinical indexes (including age, height and body mass index) of patients with idiopathic pulmonary fibrosis were confirmed by meta-analysis. The predictive value of pulmonary function, symptoms, and imaging findings for the risk of death from disease. At the same time, we believe that designing a multi-dimensional scoring system based on these results may help predict the risk of death and survival in patients with idiopathic pulmonary fibrosis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563

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