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目的:探讨慢性阻塞性肺疾病合并肺间质纤维化(PF-COPD)的特点及临床意义。方法:对2002年3月~2005年3月我院收治的经临床确诊的43例PF-COPD患者和43例特发性肺间质纤维化(IPF)患者的临床表现、X线检查、CT片/高分辨CT(HRCT)、肺功能及血气检查结果进行回顾性分析。结果:(1)PF-COPD的临床表现介于IPF、COPD之间。双肺湿啰音、桶状胸、肺界下移、肺心病体征2组差异有统计学意义(P<0.05);Velcro啰音、杵状指(趾)2组差异无统计学意义(P>0.05)。(2)X线检查及CT兼有上述IPF、COPD的特点。X线检查胸廓增大、肺透亮度增高、肺纹理紊乱2组之间差异有统计学意义(P<0.05),而肺纤维化征象(即网状/网状结节、磨玻璃改变、蜂窝改变)2组之间差异无统计学意义(P>0.05)。CT检查肺大泡、肺泡壁破坏两组之间差异有统计学意义(P<0.05);肺纤维化征象(即网状/网状结节、磨玻璃改变、蜂窝改变、胸膜下线征)2组之间差异无统计学意义(P>0.05)。(3)肺功能测定结果不完全符合单纯阻塞性或限制性通气功能障碍,多为混合性通气功能障碍。2组用力肺活量(FVC)、第一秒用力呼气量(FEV1)、第一秒用力呼气量占用力肺活量的百分率(FEV1%)差异均有统计学意义(P<0.05);2组一氧化碳弥散量(DLCO)差异无统计学意义(P>0.05)。(4)血气分析表现以低氧血症为主,部分可合并二氧化碳潴留。2组动脉氧分压(PaO2)差异无统计学意义(P>0.05);2组动脉二氧化碳分压(PaCO2)差异有统计学意义(P<0.05)。结论:PF-COPD具其有独特的临床表现,使原来单一的疾病表现不典型。胸片、CT/HRCT、肺功能,尤其是HRCT对诊断COPD合并肺间质纤维化有重要价值。
Objective: To investigate the characteristics and clinical significance of pulmonary interstitial fibrosis (PF-COPD) in patients with chronic obstructive pulmonary disease. Methods: From March 2002 to March 2005 in our hospital, 43 clinically diagnosed patients with PF-COPD and 43 patients with idiopathic pulmonary fibrosis (IPF) in patients with clinical manifestations, X-ray examination, CT High resolution CT (HRCT), lung function and blood gas examination results were retrospectively analyzed. Results: (1) The clinical manifestations of PF-COPD were between IPF and COPD. There was significant difference between the two groups (P <0.05), and there was no significant difference between the two groups (P> 0.05). There was no significant difference in Velcro rales and clubbing between the two groups > 0.05). (2) X-ray examination and CT have the above characteristics of IPF and COPD. There was significant difference between the two groups (P <0.05), while the signs of pulmonary fibrosis (ie, reticular / reticular nodules, ground glass changes, honeycomb Change) between the two groups, the difference was not statistically significant (P> 0.05). CT examination of bullae and destruction of the alveolar wall showed significant differences between the two groups (P <0.05); signs of pulmonary fibrosis (ie, reticular / reticular nodules, ground glass changes, cellular changes, and subpleural signs) There was no significant difference between the two groups (P> 0.05). (3) pulmonary function test results do not completely meet the simple obstructive or restrictive ventilation dysfunction, mostly mixed ventilation dysfunction. FVC, FEV1 and FEV1% of the first second forced expiratory volume were all significantly different (P <0.05). There was no significant difference between the two groups in carbon monoxide Diffusion (DLCO) was no significant difference (P> 0.05). (4) blood gas analysis showed hypoxemia, some may be combined with carbon dioxide retention. There was no significant difference in PaO2 between the two groups (P> 0.05). There was significant difference in PaCO2 between the two groups (P <0.05). Conclusion: PF-COPD has its unique clinical manifestations, making the original single disease manifestations are not typical. Chest radiograph, CT / HRCT, pulmonary function, especially HRCT have important value in diagnosis of COPD with pulmonary interstitial fibrosis.