阻塞_____慢性阻塞性肺疾病；肺间质纤维化；CT

慢性阻塞性肺疾病合并肺间质纤维化43例临床分析

http://www.100md.com 《新疆医科大学学报》 2005年第6期

阻塞,,慢性阻塞性肺疾病；肺间质纤维化；CT,HRCT；肺功能,1资料与方法,2结果,3讨论,参考文献：

     摘要：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。

    关键词：慢性阻塞性肺疾病；肺间质纤维化；CT/HRCT；肺功能

    Clinical analysis of 43 cases of chronic obstructive pulmonary disease with idiopathic pulmonary fibrosis

    LIU Lijuan， Qimanguli

    (Department of Respiratory Medicine，First Affiliated Hospital, Xinjiang Medical University,Urumqi 830054, China)

    Abstract: Objective: To explore the clinical characteristics and clinical significance of chronic obstructive pulmonary disease with pulmonary fibrosis (PFCOPD). Methods: Fortythree patients with PFCOPD were retrospectively analyzed by patients history, clinical symptoms, chest radiograph, CT/HRCT, lung function test and bloodgas analysis and to compare with Fortythree patients with idiopathic pulmonary fibrosis(IPF).Results: (1)Clinical characteristics of PFCOPD were between that of COPD and IPF.There was statistical significance of moist rales 、tubbiness thorax、lung boundary descend(P<0.05)； crackles, finger clubbing was nothing statistical(P>0.05).(2)Chest radiograph and CT was between COPD and pulmonary fibrosis . There was statistical significance of emphysema characteristics; diffuse linear(P<0.05),reticular and fine nodular was nothing statistical(P>0.05).(3)Lung function test showed mixed ventilation disturbances. There was statistical significance of FVC, FEV1, FEV 1%(P<0.05)； DLCO was nothing statistical (P>0.05). (4)Hypoxemia was main manifestations of arterial bloodgas analysis for PFCOPD, part coexisted with hypercarbia. There was statistical significance of PaO2(P<0.05); PaCO2 was nothing statistical(P>0.05). Conclusion: PFCOPD has unique clinical manifestation. Chest radiograph, CT/HRCT, lung function test are valuable tools to diagnose PFCOPD. ......

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