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目的研究慢性阻塞性肺疾病(COPD)合并肺间质纤维化(PIF)的临床特点并探讨其临床意义。方法对34例COPD合并PIF患者的病程、症状、体征、肺功能和血气分析、胸部X线片、胸部高分辨率CT(HRCT)进行回顾性分析,并与单纯COPD患者进行比较。结果 1与单纯COPD相比较,COPD合并PIF患者病程较长,临床多表现为混合型呼吸困难并进行性加重,肺部听诊可闻及Velcro啰音伴有杵状指(趾)(P<0.01);2合并PIF组混合性通气功能障碍发生率及肺弥散功能降低显著大于单纯COPD组,单纯COPD组阻塞性通气功能障碍发生率显著高于合并PIF组;3合并PIF组PaO2降低和PaCO2升高显著高于单纯COPD组;4影像学显示合并PIF组胸部X线片显示弥漫点状、结节状影、网格状、毛玻璃状和蜂窝状影较多,HRCT显示以支气管管壁增厚,支气管血管束增粗扭曲、变形、小叶间隔增厚为主。结论 COPD合并PIF患者由于双重的病理损害造成肺通气功能、弥散功能严重障碍和严重低氧血症,并具有独特的临床与影像学特征,影响患者预后,肺功能及HRCT可为临床提供重要的诊断依据。
Objective To study the clinical characteristics of chronic obstructive pulmonary disease (COPD) complicated with pulmonary fibrosis (PIF) and to explore its clinical significance. Methods The course, symptoms, signs, pulmonary function, blood gas analysis, chest X-ray and chest high resolution CT (HRCT) of 34 patients with COPD and PIF were retrospectively analyzed and compared with patients with simple COPD. Results Compared with simple COPD, patients with COPD complicated with PIF had a longer course of disease, mixed clinical manifestations of mixed dyspnea and progressive exacerbations, pulmonary auscultation and Velcro rales with clubbing (P <0.01) ) .2 The incidence of mixed ventilatory dysfunction and pulmonary diffuse function in PIF group was significantly lower than that in simple COPD group. The incidence of obstructive ventilatory dysfunction in COPD group was significantly higher than that in combined PIF group. (3) PaO2 decreased and PaCO2 High significantly higher than the simple COPD group; 4 imaging studies showed chest X-ray combined PIF group diffuse point, nodular shadow, mesh, frosted glass and honeycomb shadow more, HRCT showed bronchial wall thickening , Bronchovascular bundle thickening distortion, deformation, interlobular septa thickening. Conclusions COPD patients with PIF complicated with pulmonary vascular disease due to dual pathological damage, severe diffuse dysfunction and severe hypoxemia, and have unique clinical and radiological features, affecting prognosis, pulmonary function and HRCT may provide important clinical Diagnose based on.