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目的探讨特发性肺纤维化(IPF)临床特点、多层螺旋CT(MSCT)表现特征、肺功能检测结果,并对其进行危险因素分析,寻找MSCT征象及肺功能指标对IPF预后价值。方法收集河北医科大学第一医院2007年12月—2014年12月临床病理证实的46例IPF患者行薄层MSCT扫描,对预定层面的MSCT各征象累及范围进行半定量评分,并对选定MSCT征象及肺功能指标进行Cox比例风险回归模型分析。结果磨玻璃密度(包括实变)范围(HR=14.547,P=0.002,95%CI 2.626~80.580)、网状影范围(HR=0.245,P=0.047,95%CI 0.061~0.982),是否合并肺气肿(HR=0.044,P=0.027,95%CI0.003~0.702)及一氧化碳弥散量(DLCO)降低(HR=4.105,P=0.020,95%CI 1.250~13.474)是影响IPF预后的危险因素。结论磨玻璃密度影范围、网状影范围、是否合并肺气肿及DLCO减低程度提示IPF预后不良。MSCT联合肺功能检测有助于IPF诊断及预后。
Objective To investigate the clinical features of idiopathic pulmonary fibrosis (IPF), the features of multi-slice spiral CT (MSCT) and the results of pulmonary function tests. To analyze the risk factors of IPF and find out the prognostic value of MSCT and pulmonary function indexes in IPF. Methods 46 patients with IPF confirmed clinically and pathologically from the First Hospital of Hebei Medical University from December 2007 to December 2014 were examined by thin-section MSCT. Semi-quantitative scoring was performed on the range of MSCT signs at the scheduled level. Signs and lung function index Cox proportional hazards regression model analysis. Results The range of ground glass density (including consolidation) (HR = 14.547, P = 0.002, 95% CI 2.626-80.580), reticular shadow range (HR = 0.245, P = 0.047, 95% CI 0.061-0.982) The risk of emphysema (HR = 0.044, P = 0.027, 95% CI0.003-0.702) and DLCO (HR = 4.105, P = 0.020, 95% CI 1.250-13.474) factor. Conclusions The density range of ground glass, the extent of reticular shadow, and the extent of emphysema and DLCO combined decrease the poor prognosis of IPF. MSCT combined with pulmonary function tests contribute to IPF diagnosis and prognosis.