35例肺间质纤维化合并肺气肿临床分析

发布时间：2018-08-24 12:00

【摘要】：目的：探讨肺间质纤维化合并肺气肿(CPFE)患者的临床表现、肺功能、影像学等特点分析，加深国内医生对该疾病认识。方法：本研究收集2011年1月1日至2012年12月31日吉林大学白求恩第一医院呼吸内科病房接受诊治的影像学上表现符合CPFE35例，对其临床表现、病史、肺功能及胸部HRCT等相关资料进行分析。结果：35例中男32例，女3例，年龄为65±10岁，老年人（年龄＞60岁）27人（77.1%）。27例(77.1%)有长期吸烟史，吸烟指数（每天吸烟支数×吸烟年数）：100～1800包年。以活动后呼吸困难为主要症状21例（60%），咳嗽24例（68.5%），咳嗽伴咳痰23例（65.7%），咯血2例（5.7%）。胸闷、胸痛3例（8.6%），发热8例（22.9%）。双下肺爆裂音24例（68.6%），双肺散在的湿Up音8例（22.9%），双肺散在的干Up音8例（22.9%），无明显肺部体征9例（25.7%）。其中26例患者完成肺功能检查，14例（53.8%）符合混合性通气功能障碍，6例（23.1%）以阻塞性通气功能障碍为主，5例（19.2%）以限制性通气功能障碍为主，2例（7.7%）通气功能正常；26例(100%)均有弥散功能障碍，其中有2例患者状态欠佳，不能完成检查，弥散功能极重度下降，测不出数值。肺功能结果（均数±标准差）：FEV1占预计值百分比为（63±25）%，FEV1/FVC为0.77±0.10，FVC占预计值百分比为（67±14）%，VC占预计值百分比为（68±16）%，TLC占预计值百分比为（80±9）%，RV占预计值百分比为（84±24）%，Dlco占预计值百分比为（38±10）%。35例患者均行HRCT检查，其中小叶中心型肺气肿14例（40%），间隔旁型肺气肿30例（85.7%），全小叶型肺气肿2例（5.7%），肺大疱5例（14.8%）。双下肺间质性改变多位于胸膜下区，其中网格样阴影20例（57.1%），蜂窝样阴影10例（28.6%），磨玻璃样阴影19例（54.3%），牵拉支气管扩张4例（11.4%）。10例表现出慢性支气管炎合并间质性改变。31例患者行该检查，其中26例存在低氧血症，不伴有高碳酸血症。PaO2为（69±13）mmHg，PaCO2为（37±5）mmHg。23例患者完成心脏彩超检查，，其中21例（91.3%）左室舒张功能减低，4例（17.4%）左房、左室增大，3例（13.0%）右房、右室增大，8例（34.8%）肺动脉高压。结论： 1．CPFE患者在影像学、肺功能、心脏彩超等方面的表现不同于单纯的COPD、IPF患者。 2．CPFE患者HRCT示双上肺肺气肿改变以间隔旁型肺气肿为主，肺功能表现为肺总量相对正常，弥散功能显著下降。 3．CPFE患者HRCT示肺间质纤维化改变以网格状阴影及磨玻璃样阴影为主。 4．CPFE患者肺功能以轻中度混合型通气功能障碍为主，存在左心舒张功能减低。
[Abstract]:Objective: to investigate the clinical manifestations, pulmonary function and imaging features of pulmonary interstitial fibrosis complicated with emphysema (CPFE). Methods: from January 1, 2011 to December 31, 2012, the imaging findings of CPFE35 patients in respiratory department of Bethune first Hospital of Jilin University were collected, and their clinical manifestations and history were analyzed. Lung function and chest HRCT were analyzed. Results among the 35 cases, 32 were male and 3 female, aged 65 卤10 years, 27 (77.1%) and 27 (77.1%) of the elderly (age > 60) had a long history of smoking. The smoking index (smoking number per day 脳 number of smoking years) was 1 000 ~ 1 800 years. The main symptoms were dyspnea after exercise in 21 cases (60%), cough in 24 cases (68.5%), cough with expectoration in 23 cases (65.7%), hemoptysis in 2 cases (5.7%). Chest tightness, chest pain in 3 cases (8.6%), fever in 8 cases (22.9%). There were 24 cases (68.6%) with double lower lung burst, 8 (22.9%) with wet Up, 8 (22.9%) with dry Up, and 9 (25.7%) with no obvious pulmonary signs. In 26 patients, 14 cases (53.8%) had completed pulmonary function examination, 6 cases (23.1%) had mixed ventilation dysfunction, 5 cases (19.2%) had obstructive ventilation dysfunction, 2 cases (7.7%) had normal ventilation function. There were 26 cases (100%) with diffusive dysfunction, among which 2 cases were in poor condition and could not complete the examination. The diffusion function was very serious and could not be measured. Lung function results (mean 卤standard deviation): FEV1 as a percentage of predicted value is (63 卤25) FVC 0.77 卤0.10 FVC / predicted percentage is (67 卤14) VC / predicted percentage is (68 卤16) TLC percentage of predicted value is (80 卤9) RV / predicted value percentage is (84 卤24) Dlco percentage of predicted value is (84 卤24)%. (38 卤10). 35 patients were examined by HRCT. There were 14 cases of central lobular emphysema (40%), 30 cases of paracentricular emphysema (85.7%), 2 cases of whole lobular emphysema (5.7%) and 5 cases of bullae (14.8%). Most of the interstitial changes of the two inferior lungs were located in the subpleural area. Among them, 20 cases (57.1%) were reticular shadow, 10 cases (28.6%) were honeycomb shadow, 19 cases (54.3%) were glass-like shadow, 4 cases (11.4%) were tracheal bronchiectasis, and 31 cases were chronic bronchitis complicated with interstitial changes. Among them, 26 cases had hypoxemia. No hypercapnia. PaO2 was (69 卤13) mmHg,PaCO2, (37 卤5) mmHg.23. 21 cases (91.3%) had left ventricular diastolic dysfunction, 4 cases (17.4%) had left atrium, 3 cases (13.0%) had left ventricular enlargement and 8 cases (34.8%) had pulmonary hypertension. Conclusion: the imaging, pulmonary function and color Doppler echocardiography in 1.CPFE patients are different from those in simple COPD,IPF patients. The changes of bilateral upper pulmonary emphysema in 2.CPFE patients are mainly paracentricular emphysema. The lung function shows that the total amount of lung is relatively normal, Diffusion function was significantly decreased in 3.CPFE patients. HRCT showed that the main changes of pulmonary interstitial fibrosis were reticular shadow and glass-like opacity. Pulmonary function in 4.CPFE patients was mainly characterized by mild to moderate mixed ventilation dysfunction. Left ventricular diastolic function was decreased.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9

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