Relevance Analysis of Changes in Clinical Indicators and Pulmonary Physiological Parameters and Prognosis of Idiopathic Pulmonary Fibrosis

doi:10.3969/j.issn.1007-9572.2016.35.010

Abstract

Abstract: Objective　 To assess the relationship between the changing quantities at different times of clinical indicators,pulmonary physiological parameters and the prognosis of patients with idiopathic pulmonary fibrosis（IPF）.Methods　126 patients with IPF，who received treatment in the First Hospital of China Medical University and the Affiliated Hospital of Logistics College of Chinese People’s Armed Police Forces from January 2001 to August 2008，were selected as research objects.According to the follow-up time，the patients were followed up for 6 months（followed-up of 4-8 months，81 cases）and 12 months（followed-up of 9-15 months，52 cases）were analyzed.The relationship between the changing quantity of clinical indicators,pulmonary physiological parameters〔dyspnea score，forced expiratory volume in first second（FEV1），forced vital capacity（FVC），total lung volume（TLC），residual volume（RV），diffusing capacity of carbon monoxide（DLCO），oxygen partial pressure（PaO2），partial pressure of carbon dioxide（PaCO2），oxygen saturation（SaO2）and alveolar-arterial partial pressure of oxygen difference（PA-aO2）〕,compared with underlying variables（underlying variables-variables within follow-up for 6 months；underlying variables-variables within follow-up for 12 months），changing ratio（changing quantity/underlying variables）and the prognosis of the IPF patients was analyzed.At the same time，taking the changing ratio as the grouping standard，the patients who were followed up for 6 months and 12 months in this study were respectively divided into improvement group，stable group and worsening group.Log-rank method was used to compare the differences in between-group survival rates of various clinical and pulmonary physiological parameters at the 6th month and the 12th month.The prognostic factors of IPF patients were analyzed by Cox proportional hazards regression.Results　52 patients had a follow-up of 13 to 84 months，and the median survival time was 51 months〔95%CI（22，56）〕.The results of univariate Cox proportional hazards regression analysis showed as follows：the changing value and ratio of dyspnea scores and the FEV1，FVC，TLC，DLCO，PaO2，SaO2，PA-aO2 at the 6th month and the 12th month were the influencing factors of IPF patients’ prognosis（P<0.05）.There were significant differences of survival rate of improvement group，stable group and worsening group of dyspnea scores，FVC，DLCO，PaO2，SaO2 and PA-aO2 at the 6th and the 12th month，and TLC at the 12th month（P<0.05）.Multivariate Cox proportional hazards regression analysis showed that the changing ratio of dyspnea scores〔HR=1.131，95%CI（1.044，1.311），P=0.027〕, FVC〔HR=0.899，95%CI（0.709，0.945），P<0.001〕 and PaO2〔HR=0.957，95%CI（0.890，0.987），P=0.034〕 were the influencing factors of the prognosis of IPF patients at the 6th month；the changing ratio of FVC〔HR=0.838，95%CI（0.811，0.910），P<0.001〕，TLC〔HR=0.962，95%CI（0.890，0.987），P=0.048〕and DLCO〔HR=0.932，95%CI（0.875，0.967），P<0.001〕 were the influencing factors of the prognosis of IPF patients at the 12th month.ConclusionClinical indicators and pulmonary physiological parameters are easy to determine with good reproducibility，which can be the monitoring indicators of IPF patients’ prognosis.The changing ratio of the parameters at 6th month and 12th month can better predict the prognosis of patients with IPF.

Key words: Idiopathic pulmonary fibrosis, Prognosis, Proportional hazards models, Vital capacity

摘要： 目的评估临床和肺生理指标的时间变化量与特发性肺纤维化（IPF）患者预后的关系。方法　选择2001年1月—2008年8月中国医科大学附属第一医院和武警后勤学院附属医院诊治的126例IPF患者为研究对象，根据随访时间，对随访6个月（纳入随访4～8个月的患者，81例）和12个月（纳入随访9～15个月的患者，52例）时的患者进行分析。分析临床和肺生理指标〔呼吸困难评分、第1秒用力呼气末容积（FEV1）、用力肺活量（FVC）、肺总量（TLC）、残气容积（RV）、一氧化碳弥散量（DLCO）、氧分压（PaO2）、二氧化碳分压（PaCO2）、血氧饱和度（SaO2）和肺泡-动脉氧分压差（PA-aO2）〕较基础变量的变化量（基础变量-随访6个月的变量；基础变量-随访12个月的变量）和变化率（变化量/基础变量）与IPF患者预后的关系。同时，依据各指标变化率作为分组的标准，将随访6个月时和12个月时的患者分别分为改善组、稳定组和恶化组。采用Log-rank检验比较随访6个月和12个月时各指标改善组、稳定组和恶化组生存率的差异。采用Cox比例风险回归分析IPF患者预后的影响因素。结果　52例患者随访13～84个月，中位生存期为51〔95%CI（22，56）〕个月。单因素Cox比例风险回归分析结果显示：随访6个月和12个月时呼吸困难评分、FEV1、FVC、TLC、DLCO、PaO2、SaO2、PA-aO2变化量、变化率是IPF患者预后的影响因素（P<0.05）。随访6个月和12个月时，呼吸困难评分、FVC、DLCO、PaO2、SaO2和PA-aO2以及随访12个月时TLC改善组、稳定组、恶化组组间生存率比较，差异有统计学意义（P<0.05）。多因素Cox比例风险回归分析结果显示：随访6个月时：呼吸困难评分变化率〔HR=1.131，95%CI（1.044，1.311），P=0.027〕、FVC变化率〔HR=0.899，95%CI（0.709，0.945），P<0.001〕和PaO2变化率〔HR=0.957，95%CI（0.890，0.987），P=0.034〕是影响IPF患者预后的因素；随访12个月时：FVC变化率〔HR=0.838，95%CI（0.811，0.910），P<0.001〕、TLC变化率〔HR=0.962，95%CI（0.890，0.987），P=0.048〕和DLCO变化率〔HR=0.932，95%CI（0.875，0.967），P<0.001〕是影响IPF患者预后的因素。结论　临床和肺生理指标易测定、重复性好，可作为IPF患者预后监测指标，6个月和12个月指标的变化率可较好地预测IPF患者的预后。

关键词: 特发性肺纤维化, 预后, 比例危险度模型, 肺活量

PENG Shou-chun, LI Xue-ren. Relevance Analysis of Changes in Clinical Indicators and Pulmonary Physiological Parameters and Prognosis of Idiopathic Pulmonary Fibrosis[J]. Chinese General Practice, 2016, 19(35): 4338-4345.

彭守春, 李学任. 特发性肺纤维化患者临床和肺生理指标的变化及其与预后关联性的研究[J]. 中国全科医学, 2016, 19(35): 4338-4345.

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