摘要
目的探究特发性肺间质纤维化(IPF)并发肺气肿的临床特征并构建风险预测模型。方法选取2017年6月—2021年4月于国药同煤总医院呼吸与危重症医学科就诊的IPF并发肺气肿患者66例为观察组,同期收治的单纯IPF患者72例为对照组。比较2组患者临床资料、动脉血气指标、肺功能指标;采用多因素Logistic回归分析IPF并发肺气肿的危险因素,使用筛选出的有价值变量构建列线图预测模型并进行模型评价。所有患者随访1年,比较2组患者生存情况。结果观察组患者吸烟比例、反流性食管炎比例、干咳比例、白介素-4(IL-4)、肿瘤坏死因子α(TNF-α)、动脉血氧分压(PaO 2)水平及肺总量(TLC)、肺活量(VC)高于对照组[t(χ^(2))/P=7.845/0.005、6.661/0.010、4.246/0.039、2.313/0.022、3.011/0.003、2.911/0.004、3.744/<0.001、2.016/<0.046],而一氧化碳弥散量(D LCO)低于对照组(t/P=3.653/<0.001)。多因素Logistic回归分析结果显示,吸烟、反流性食管炎、IL-4高、TNF-α高、PaO 2高、TLC高是IPF并发肺气肿的独立危险因素[OR(95%CI)=1.509(1.117~2.941)、2.746(1.968~3.535)、1.262(1.021~3.517)、2.158(1.469~3.998)、1.724(1.055~2.653)、1.396(1.116~2.240),P均<0.05],D LCO高是其保护因素[OR(95%CI)=0.717(0.346~0.966),P=0.018]。基于7项独立预测因素建立的列线图模型验证结果显示,受试者工作特征曲线下面积为0.846,C-index指数为0.835,Hosmer-Lemeshow拟合优度检验显示出较好的拟合度(P=0.832),且具有较高的净获益值。随访结果显示,2组患者1年生存率比较差异无统计学意义(P>0.05)。结论吸烟、反流性食管炎、IL-4、TNF-α、PaO 2、TLC、D LCO是IPF并发肺气肿的影响因素,其所构建的列线图预测模型能够简便快捷地预测并发肺气肿风险。
Objective To explore the clinical characteristics of idiopathic pulmonary fibrosis(IPF) complicated with emphysema and build a risk prediction model.Methods From June 2017 to April 2021, 66 patients with IPF complicated with emphysema who were treated in the Department of Respiratory and Critical Care Medicine of Sinopharm Tongmei General Hospital were selected as the observation group, and 72 patients with simple IPF who were treated in the same period were selected as the control group. The clinical data, arterial blood gas index and pulmonary function index of the two groups were compared;Multivariate logistic regression was used to analyze the risk factors of IPF complicated with emphysema, and the nomogram prediction model was constructed using the selected valuable variables and the model was evaluated. All patients were followed up for 1 year, and the survival of the two groups was compared. Results The proportion of smoking, reflux esophagitis, dry cough, interleukin-4(IL-4) and tumor necrosis factor in the observation groupα(TNF-α), The level of arterial partial pressure of oxygen(PaO), total lung capacity(TLC) and vital capacity(VC) were higher than those in the control group [t(χ^(2))/P=7.845/0.005, 6.661/0.010, 4.246/0.039, 2.313/0.022, 3.011/0.003, 2.911/0.004, 3.744/<0.001, 2.016/<0.046],while carbon monoxide dispersion(DCO) was lower than that in the control group(t/P=3.653/<0.001). Multivariate logistic regression analysis showed that smoking, reflux esophagitis, high IL-4, TNF-α High PaO, high TLC are independent risk factors of IPF complicated with emphysema [OR(95%CI)=1.509(1.117-2.941), 2.746(1.968-3.535), 1.262(1.021-3.517), 2.158(1.469-3.998), 1.724(1.055-2.653), 1.396(1.116-2.240), all P<0.05], and high DCO is a protective factor [OR(95%CI)=0.717(0.346-0.966),P=0.018]. The validation results of the nomogram model based on seven independent predictors showed that the area under the working characteristic curve of the subjects was 0.846, the C-index was 0.835, and the Hosmer Lemeshow goodness of fit test showed a good degree of fit(P=0.832), with a high net benefit value. The follow-up results showed that there was no significant difference in 1-year survival rate between the two groups(P>0.05). Conclusion Smoking, reflux esophagitis, IL-4, TNF-α, PaO, TLC and DCO are the influencing factors of IPF complicated with emphysema, and the nomogram prediction model constructed by them can simply and quickly predict the risk of complicated emphysema.
作者
康冬梅
高勇
马继芳
赵海
Kang Dongmei;Gao Yong;Ma Jifang;Zhao Hai(Department of Respiratory and Critical Care Medicine,Sinopharm Tongmei General Hospital,Shanxi Province,Datong 037003,China)
出处
《疑难病杂志》
CAS
2022年第12期1236-1241,共6页
Chinese Journal of Difficult and Complicated Cases
关键词
特发性肺间质纤维化
肺气肿
临床特征
影响因素
列线图
Idiopathic pulmonary fibrosis
Emphysema
Clinical features
Influence factor
Nomogram
