THE DIAGNOSIS AND THE TREATMENT BY STEROIDS IN DIOPATHIC INTERSTITIAL PNEUMONIAS BASED ON THE TRANSBRONHIAL LUNG BIOPSY

基于经支气管肺活检的特发性间质性肺炎的诊断和类固醇治疗

基本信息

批准号：
16590770
负责人：
WATANABE Kentaro
金额：
$ 2.08万
依托单位：
Fukuoka University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2007
项目状态：
已结题

项目摘要

Background: Recently, increasing numbers of clinical investigations of combined pulmonary fibrosis and emphysema (CPFE) have been published. However, the relationship between the temporal decrease of respiratory function and the prognosis is not well known.Methods: This study was performed to quantify the annual change in respiratory function of patients with CPFE and to compare the relationship between the change in respiratory function and survival in CPFE patients with that of patients with idiopathic pulmonary fibrosis alone (IPF-alone). Of patients who were diagnosed with IPF at discharge from our department, 32 who met the following criteria were selected as CPFE patients: 1) the presence of dyspnoea of insidious onset, 2) a computed tomography (CT) scan showing both round areas with low attenuation suggestive of emphysema and diffuse reticular opacities with sub-pleural predominance, 3) impaired ventilatory and/or diffusing capacity, and 4) an absence of known causes of pulmonar … More y fibrosis. Fifty-five patients who met the following criteria were categorized as having IPF alone: 1) a CT scan showing diffuse reticular opacities with sub-pleural predominance but no emphysema, 2) compliance with criteria 1, 3, and 4 as described for CPFE patients. The survival was compared between these 2 groups using Kaplan-Meier method. Of these patients, 26 CPFE and 33 IPF-alone patients who had undergone repeated respiratory function tests with at least one-year interval were selected for the further analysis of respiratory functions and survival.Results: Results are expressed as medians and ranges. The baseline vital capacity (VC) of CPFE patients was greater than that of patients with IPF alone (90% [28%-132%] vs. 73% [28%-113%], respectively, p=0.018). The annual % decrease in VC from the baseline was significantly less in CPFE patients than in those with IPF alone (-3.1% [-7.8% to +10.7%] vs. -6.1% [-33.7% to +1.4%], respectively, p<0.001). Baseline diffusing-capacity (DL_co) was significantly lower in patients with CPFE than in those with IPF alone (46% [9%-75%] vs. 59.5% [15%-103%], respectively, p=0.003). DL_co/VA (transfer factor) at baseline was also lower in CPFE patients than in those with IPF alone (53% [8%-82%) vs. 76% [40%-126%], respectively, p<0.001). However, the annual decreases in DL_co and DL_co/VA in CPFE patients were modest compared with those of patients with IPF alone (DL_co: -2.4% [-16.5% to 8.1%] vs. -11.9% [-33.8% to +4.2%], respectively, p = 0064; DL_co/VA:-3.9% [-25.6% to +7.8%] vs.-3.4% [-28.0% to +15.3%], respectively, p = 0.464). Survival of 32 CPFE patients was significantly longer than that of 55 patients with IPF-alone according to Kaplan-Meier analysis (p = 0.043).Conclusion : Well-preserved lung volume in combined pulmonary fibrosis and emphysema complicates prediction of the prognosis of CPFE. Detection of coexistent emphysema in IPF patients using CT is important to avoid making an erroneous prognosis. Delay of the temporal decrease of ventilatory and diffusing capacity needs to be further analyzed as a prognostic indicator of CPFE. Less

背景：最近，已经发表了越来越多的肺纤维化和肺气肿（CPFE）的临床研究。然而，呼吸功能暂时降低与预后之间的关系尚不清楚。方法：进行了这项研究，以量化CPFE患者呼吸功能的年度变化，并比较患有异化性肺纤维化患者的CPFE患者的呼吸功能变化与单独使用CPFE患者的生存率之间的关系（ipf-alone（ipf-alone））。在我们部门出院时被诊断出IPF的患者，符合以下标准的32例被选为CPFE患者：1）存在阴险发作的呼吸困难，2）计算机断层扫描（CT）扫描，显示两个圆形区域，表现出较低的衰减表现出了表现出色的肿瘤和较低的衰减能力，并且具有较低的衰减能力和差异性且不变的且不变的预期/3）及3）及3），3）缺乏肺部的已知原因……更多的纤维化。符合以下标准的55例患者被归类为单独的IPF：1）CT扫描显示弥漫性网状OCITAL占主导地位，但没有肺气肿，2）符合CPFE患者所述的标准1、3和4。使用Kaplan-Meier方法比较了这两组之间的存活率。在这些患者中，选择了至少一年间隔的26例CPFE和33名单位重复呼吸功能测试的患者，以进一步分析呼吸功能和生存。结果：结果表示为中位数和范围。 CPFE患者的基线生命力（VC）大于仅IPF患者（90％[28％-132％]和73％[28％-113％]，P = 0.018）。 CPFE患者的VC的年％降低明显少于仅IPF的患者（-3.1％[-7.8％至 +10.7％）和-6.1％[-33.7％至 +1.4％]，p <0.001）。 CPFE患者的基线扩散容量（DL_CO）明显低于仅IPF的患者（46％[9％-75％]和59.5％[15％-103％]，P = 0.003）。 CPFE患者的基线时DL_CO/VA（转移因子）也比仅IPF（53％[8％-82％）和76％[40％-126％]的DL_CO/VA（转移因子）低于p <0.001）。但是，与仅IPF的患者相比，CPFE患者DL_CO和DL_CO/VA的年度下降是适度的（DL_CO：-2.4％[-16.5％至8.1％]，-11.9％[-33.8％至 +4.2％]，分别为p = 0064; dl_co/va：-25.3.9％[-2.4％]：-25. 3.9％[-2.4％] [-2.4％] [-2.4％] [-2.4％] [-2.4％] [-2.4％] [-2.4％] [-2.4％] [-2.4％] [-2.4％] -2.4％[-2.4％[-2.4％] -2.4％。 [-28.0％至 +15.3％]，p = 0.464）。根据Kaplan-Meier分析（p = 0.043），32例CPFE患者的存活率明显长于55例IPF-OLONO的患者。结论：结合肺纤维化和肺气肿的保存完好的肺部体积使CPFE预后的预测复杂化。使用CT检测IPF患者中共存的肺气肿对于避免发出错误的提示很重要。需要进一步分析通气和扩散能力的暂时延迟，作为CPFE的预后指标。较少的