间质性肺病并发呼吸衰竭的危险因素分析及风险预测模型建立

Analysis of risk factors and establishment of risk prediction model on interstitial lung disease complicated with respiratory failure

摘要:

目的：探讨间质性肺病（interstitial lung disease，ILD）并发呼吸衰竭（respiratory failure，RF）患者的临床特点，比较其差异，分析其并发RF的危险因素，同时建立风险预测模型。方法：回顾性分析2013年1月至2018年1月于重庆医科大学附属第一医院住院的ILD患者291例，将其分为伴RF组（98例）与不伴RF组（193例），分析比较其临床资料，并进一步行logistic回归分析。建立模型，采用Hosmer-Lemeshow拟合优度检验和受试者工作特征曲线（receiver operator characteristic curve，ROC曲线）对该模型进行评估。结果：5年期间，ILD并发RF的患者占所有ILD住院患者的33.7%。与不伴RF组相比，伴RF组住院期间死亡率明显增高，为17.3%。2组患者在主要症状、症状加重时间、吸烟指数、C反应蛋白（C-reactive protein，CRP）、胸部CT病灶范围等方面均存在统计学差异。Logistic回归分析发现，症状短时间内急性加重、有气促表现、CRP升高、胸部CT弥漫性病灶等是ILD患者并发RF的独立危险因素。所建立的logistic回归模型ROC曲线下面积为0.854（95%CI=0.805~0.903），灵敏度为67.1%，特异度为89.5%。结论：对于短时间内症状急性加重，且以气促为主要临床表现，伴血CRP水平升高，胸部影像学检查提示弥漫性病变，伴新发磨玻璃影，或合并心血管病史、肺部感染的ILD患者，应提高警惕，此类患者并发呼吸衰竭的可能性大，住院死亡率极高，最终结局差。基于危险因素建立的风险预测模型对ILD患者是否会发生RF有一定的预测价值，可用于指导临床实践。

Abstract:

Objective：To explore the clinical characteristics of interstitial lung disease（ILD） complicated with respiratory failure （RF），compare their differences，analyze their risk factors of ILD with RF，and establish a risk prediction model. Methods：A total of 291 patients with ILD in our hospital from January 2013 to January 2018 were retrospectively analyzed and were divided into the case group（n=98） and the control group（n=193）. Their clinical data were compared and analyzed，and logistic regression analysis was used. The model was established，and Hosmer-Lemeshow goodness of fit test and receiver operating characteristic（ROC） curve were used to evaluate the model. Results：During the past 5 years，patients with ILD and RF were taken 33.7% among all hospitalized pa－tients with ILD. Compared with the control group，the mortality in the case group was significantly increased，accounting for 17.3%. Patients in the two groups had significant differences in main symptoms，the aggravated time of symptoms，smoking index，C-reactive protein（CRP） and the lesion of chest CT（P<0.05）. Logistic regression analysis revealed that acute exacerbation within short time，dyspnea，increased CRP，and CT diffusion focus were independent risk factors of patients with ILD and RF. The area under the ROC curve for the evaluation model was 0.854（95%CI=0.805-0.903），with sensitivity of 67.1% and specificity of 89.5%. Conclusion：More attention should be paid to ILD patients who have an acute exacerbation in short time，with dyspnea as main symptom，accompanying with high CRP level，diffuse lesion and ground-glass opacity，or combined with cardiovascular disease and pulmonary infection. Because those patients may be more likely to have RF，with high mortality and poor final outcome. The risk prediction model might be an effective tool for predicting whether there will be respiratory failure of ILD patients，with can be used for clinical practice.