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目的探讨277例弥漫性实质性肺疾病住院患者死亡的影响因素。方法本院呼吸内科弥漫性实质性肺疾病(DPLD)的病例依据病因分为结缔组织疾病相关DPLD组(CTD-IP)、其他已知病因DPLD组和特发性间质性肺炎(IIPS)组,每组按预后情况分又为非死亡组和死亡组两个亚组,采用病例对照的研究方法进行风险因素回顾性分析。结果 IIPS组死亡亚组年龄平均、基础疾病患病率及CRP、ALT、AST指标高于非死亡组,CTD-IP组死亡亚组的CRP、WBC、AST指标高于非死亡组,其他病因组两亚组的病因构成提示有统计学差异,其死亡亚组CRP、PT、APTT、ALT、AST高于非死亡组。将上述各组指标进行曲线分析,AUC大于0.7指标作为死亡风险预测指标,并计算出其截断点作为最佳诊断阈值纳入多因素logistics回归分析。结果显示IIPS组中CRP>40(mg/L)和年龄>70(岁)、CTD-IP中CRP>40(mg/L)、其他组中CRP>50(mg/L)为独立死亡危险因素。结论 CRP升高、高龄及药物继发性DPLD是弥漫性实质性肺疾病患者住院死亡的危险因素,其中前者是DPLD患者的共同危险因素,而后两者分别是IIPS组和其他病因组的独立危险因素。上述因素在用于预测不同类型DPLD患者死亡风险中需区别分析。
Objective To investigate the influencing factors of death in 277 patients with diffuse parenchymal lung disease. Methods The cases of diffuse pulmonary parenchymal disease (DPLD) in our hospital were divided into three groups: the DPLD group (CTD-IP), DPLD group and the idiopathic interstitial pneumonia group (IIPS) According to the prognosis, each group was divided into two subgroups: non-death group and death group. A case-control study was conducted to retrospectively analyze the risk factors. Results The average age, the prevalence of underlying diseases and the indexes of CRP, ALT and AST in the death subgroup of IIPS group were higher than those in non-death group. The CRP, WBC and AST indexes in the death subgroup of CTD-IP group were higher than those in non-death group and other etiologies Etiology of the two sub-groups suggest that there are statistical differences, the death subgroup CRP, PT, APTT, ALT, AST than non-death group. The above indexes of each group were analyzed by curve analysis. The AUC> 0.7 was taken as the predictor of death risk, and the truncated point was calculated as the best diagnostic threshold for inclusion in the multi-factor logistics regression analysis. CRP> 40 (mg / L) and age> 70 (years), CRP> 40 (mg / L) in CTD-IP and CRP> 50 (mg / L) in other groups were independent risk factors for death in IIPS group . Conclusions Elevated CRP, advanced age and drug-induced secondary DPLD are risk factors for in-hospital mortality in patients with diffuse parenchymal lung disease, of which the former is a common risk factor for DPLD and the latter two are independent risk for IIPS and other etiologies, respectively factor. These factors need to be differentially analyzed for predicting the risk of death in patients with different types of DPLD.