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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
赵铁梅,刘凯迪,段智梅,华琳,张明月,圣朝军,吴洁.纤维化性间质性肺疾病预后因素的前瞻性队列研究[J].中华老年多器官疾病杂志,2021,20(6):414~418
纤维化性间质性肺疾病预后因素的前瞻性队列研究
Prognostic factors for fibrosing interstitial lung diseases:a prospective cohort study
投稿时间:2021-02-01  
DOI:10.11915/j.issn.1671-5403.2021.06.086
中文关键词:  肺疾病,间质性;预后;危险性评估
英文关键词:lung diseases, interstitial; prognosis; risk assessment This work was supported by the Project of Health Bureau of Logistics Support Department of Military Commission
基金项目:军委后勤保障部卫生局课题(18BJZ21)
作者单位E-mail
赵铁梅 解放军总医院第一医学中心呼吸与危重症医学科,北京 100853 ztm1111@sina.comprognostic 
刘凯迪 解放军总医院第一医学中心呼吸与危重症医学科,北京 100853 ztm1111@sina.comprognostic 
段智梅 解放军总医院第一医学中心呼吸与危重症医学科,北京 100853 ztm1111@sina.comprognostic 
华琳 首都医科大学生物医学工程学院生物医学信息学系数学与生物信息学教研室,北京 100069 ztm1111@sina.comprognostic 
张明月 解放军总医院第一医学中心呼吸与危重症医学科,北京 100853 ztm1111@sina.comprognostic 
圣朝军 解放军总医院第一医学中心呼吸与危重症医学科,北京 100853 ztm1111@sina.comprognostic 
吴洁 解放军总医院第一医学中心呼吸与危重症医学科,北京 100853 ztm1111@sina.comprognostic 
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中文摘要:
      目的 探讨纤维化性间质性肺疾病的临床特点和发展为进行性纤维化型及死亡的风险因素。方法 选择2019年5月至12月解放军总医院呼吸科收治的58例纤维化性间质性肺疾病患者为研究对象。收集临床资料,行肺CT、肺功能等检查,同时行6min步行试验,应用加利福尼亚大学圣地亚哥分校呼吸困难问卷(SOBQ)进行呼吸困难评分,并随访至1年进行病情评估。应用SPSS 19.0软件和R 3.6.1软件进行统计分析。根据数据类型,分别采用t检验或χ2检验进行组间比较。采用竞争风险模型的生存分析和Fine-Gray回归模型提取发展为进行性纤维化型和死亡风险的影响因素。结果 58例患者中,35例(60.34%)诊断为特发性肺纤维化(IPF),14例(24.14%)诊断为结缔组织病相关间质性肺病,9例(15.52%)归为其他原因所致的肺纤维化;12例(20.69%)患者发展为进行性纤维化型,8例(13.79%)患者死亡(6例死于纤维化急性加重)。单因素分析结果显示,发展为进行性纤维化型的风险因素是诊断为IPF、高分辨CT(HRCT)网格影评分和蜂窝影评分高,死亡的风险因素是6min步行距离短(<300m的患者死亡率明显增高)、SOBQ评分高。多因素分析结果显示,HRCT网格影评分高是发展为进行性纤维化型的风险因素(RC=0.687,HR=1.99,95%CI 1.03~3.85,P=0.042),未发现死亡的风险因素。结论 诊断为IPF、HRCT网格影和蜂窝影评分高的患者发展为进行性纤维化型的风险更高;6min步行距离<300m、SOBQ评分高的患者死亡风险更高。
英文摘要:
      Objective To investigate the clinical characteristics of fibrosing interstitial lung diseases, and explore its risk factors of mortality and of developing a progressive phenotype. Methods A total of 58 patients who suffered from fibrosing interstitial lung diseases admitted to the Chinese PLA General Hospital during May and December 2019 were prospectively enrolled in this study. Their clinical data were collected. And chest CT scanning, lung function test and 6-minute walk test(6MWT) were performed. The dyspnea score was assessed with the University of California, San Diego shortness of breath questionnaire (SOBQ). The patients were followed up for 1 year to evaluate the condition. SPSS statistics 19.0 and R 3.6.1 were used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison for different data types. Competing risk model and Fine-Gray competing risk regression model were adopted to extract the risk factors of progressive fibrosis and mortality. Results Of the 58 patients, 35 (60.34%) were diagnosed as idiopathic pulmonary fibrosis (IPF), 14 (24.14%) as interstitial lung disease associated with connective tissue diseases, and 9 (15.52%) as pulmonary fibrosis caused by other causes. Twelve cases (20.69%) developed into progressive fibrotic phenotype, and 8 (13.79%) died, including 6 due to acute exacerbation of fibrosis. Univariate analysis showed that the risk factors for the development of progressive fibrotic phenotype were diagnosis of IPF, high reticular score and honeycombing score in high resolution CT (HRCT) scans, and the risk factors for death were short 6-minute walk distance (the dead had a significantly higher ratio of shorter than 300 m) and higher SOBQ score. Multivariate analysis showed that high HRCT reticular score was the risk factor for progressive fibrotic phenotype (RC=0.687, HR=1.99,95%CI 1.03-3.85, P=0.042), and no risk factors for death were found. Conclusion Patients with IPF, high HRCT reticular and honeycombing scores are at a higher risk of developing progressive fibrotic phenotype. Those with 6-minute walk distance shorter than 300 m and higher SOBQ scores are prone to death.
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