论文部分内容阅读
目的分析慢性阻塞性肺疾病(COPD)合并肺间质纤维化(PIF)的临床及病理变化特点。方法选取常德职业技术学院附属二医院2013年4月—2015年4月收治的COPD合并PIF患者62例为观察组,并选取同期单纯COPD患者62例为对照组。两组患者均实施标准化的体格检查,应用胸部X线检查、肺部HRCT检查,观察两组患者临床症状(Velcro啰音、杵状指、桶状胸、呼气性呼吸困难、混合型呼吸困难)、吸烟情况、胸部影像学表现、肺功能〔用力肺活量占预计值的百分比(FVC%)、第1秒用力呼气容积占预计值的百分比(FEV1%)、第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、一氧化碳弥散量(DLCO)〕、血气分析指标〔动脉氧分压(Pa O2)、动脉二氧化碳分压(Pa CO2)〕。结果观察组患者Velcro啰音、杵状指、混合型呼吸困难发生率高于对照组,桶状胸、呼气性呼吸困难发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者吸烟率高于对照组,每年吸烟量高于对照组,吸烟史长于对照组,差异有统计学意义(P<0.05)。经X线检查发现,观察组弥漫点状结节状影、网格状蜂窝状影发生率高于对照组,差异有统计学意义(P<0.05)。经HRCT检查发现,观察组患者毛玻璃状样变、纵隔淋巴结肿大发生率高于对照组,差异有统计学意义(P<0.05)。观察组患者FVC%、FEV1%、DLCO低于对照组,FEV1/FVC高于对照组,差异有统计学意义(P<0.05)。观察组患者Pa O2、Pa CO2低于对照组,差异有统计学意义(P<0.05)。结论 COPD合并PIF患者因受到双重病理损害,导致其肺通气功能、弥散功能出现更为严重的障碍,且低氧血症更为明显,对预后产生不利影响。
Objective To analyze the clinical and pathological characteristics of chronic obstructive pulmonary disease (COPD) complicated with pulmonary interstitial fibrosis (PIF). Methods Sixty-two patients with COPD complicated with PIF who were admitted to the Second Affiliated Hospital of Changde Vocational and Technical College from April 2013 to April 2015 were selected as the observation group and 62 patients with COPD in the same period were selected as the control group. The two groups of patients were standardized physical examination, the application of chest X-ray examination, pulmonary HRCT examination to observe the clinical symptoms of two groups (Velcro rales, clubbing, barrel chest, expiratory breathing difficulties, mixed breathing difficulties ), Smoking status, chest radiographic performance, lung function (FVC% of forced vital capacity,% of predicted forced expiratory volume in 1 second (FEV1%), forced expiratory volume in 1 second (FEV1 / FVC), diffuse volume of carbon monoxide (DLCO)], blood gas analysis index (Pa O2, PaCO2). Results The incidence of Velcro rales, clubbing and mixed dyspnea in observation group was higher than that in control group. The incidence of barrel chest and expiratory dyspnea was lower than that of control group (P <0.05). The smoking rate in the observation group was higher than that in the control group, and the annual smoking amount was higher than that in the control group. The smoking history was longer than that in the control group (P <0.05). The X-ray examination found that the observation group diffuse punctate nodular shadow, the incidence of grid-shaped honeycomb was higher than the control group, the difference was statistically significant (P <0.05). HRCT examination found that the observation group patients with frosted glassy change, mediastinal lymph node enlargement incidence was higher than the control group, the difference was statistically significant (P <0.05). FVC%, FEV1% and DLCO in the observation group were lower than those in the control group, and the FEV1 / FVC was higher in the observation group than in the control group (P <0.05). PaO2 and PaCO2 in the observation group were lower than those in the control group, with significant difference (P <0.05). Conclusion Patients with COPD complicated with PIF suffer from double pathological damage, resulting in more severe obstructions of pulmonary ventilation and diffusibility. Hypoxemia is more obvious and has an adverse effect on prognosis.