呼气末正压通气氧合对特发性肺纤维化急性加重期的预后评估：一项回顾性队列研究

Prognostic evaluation by oxygenation with positive end-expiratory pressure in acute exacerbation of idiopathic pulmonary fibrosis: A retrospective cohort study.

作者信息

Suzuki Atsushi, Taniguchi Hiroyuki, Ando Masahiko, Kondoh Yasuhiro, Kimura Tomoki, Kataoka Kensuke, Matsuda Toshiaki, Yokoyama Toshiki, Sakamoto Koji, Hasegawa Yoshinori

机构信息

Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.

Center for Advanced Medicine and Clinical Research, Nagoya University, Hospital, Nagoya, Aichi, Japan.

出版信息

Clin Respir J. 2018 Mar;12(3):895-903. doi: 10.1111/crj.12602. Epub 2017 Jan 12.

DOI:10.1111/crj.12602

PMID:28026113

Abstract

INTRODUCTION

Acute exacerbation (AE) is a severe complication of idiopathic pulmonary fibrosis (IPF), which shares some common pathological features with acute respiratory distress syndrome (ARDS). The new definition of ARDS requires positive end-expiratory pressure (PEEP) to assess gas exchange and has better predictive validity for short-term mortality compared with the previous definition.

OBJECTIVES

The aim of this study was to evaluate the prognostic utility of oxygenation with PEEP in AE-IPF.

METHODS

We performed a retrospective cohort study using the data of AE-IPF patients between 2007 and 2015. At the time of diagnosis, PaO /FiO was evaluated before and 30 minutes after PEEP. We evaluated the prognostic utility of PaO /FiO with PEEP after including other candidate prognostic factors. Considering the definition of ARDS, patients with AE-IPF were classified into a severe group (PaO /FiO ≤ 300 with PEEP) and a non-severe group (PaO /FiO > 300 with PEEP).

RESULTS

We identified 62 consecutive patients with AE-IPF. All patients were treated with mechanical ventilation on the first day. The median PaO /FiO before and 30 minutes after PEEP was significantly increased (237.5-425.5, P < .001). In multivariate Cox proportional analysis, Krebs von den Lungen-6 (KL-6) (HR 1.239; 95%CI 1.050-1.461; P = .011), D-dimer (HR 1.039; 95%CI 1.015-1.064; P = .001), % neutrophils in bronchoalveolar lavage fluid (HR 1.015; 95%CI 1.003-1.027; P = .017), and being in the severe group (HR 3.233; 95%CI 1.503-6.957; P = .003) had significant impacts on survival up to 90 days.

CONCLUSION

Evaluation of oxygenation with PEEP may provide useful information for predicting short-term mortality in patients with AE-IPF.

摘要

引言

急性加重（AE）是特发性肺纤维化（IPF）的一种严重并发症，它与急性呼吸窘迫综合征（ARDS）具有一些共同的病理特征。ARDS的新定义要求使用呼气末正压（PEEP）来评估气体交换，与先前的定义相比，其对短期死亡率具有更好的预测效度。

目的

本研究旨在评估使用PEEP进行氧合评估在AE-IPF中的预后价值。

方法

我们利用2007年至2015年间AE-IPF患者的数据进行了一项回顾性队列研究。在诊断时，于使用PEEP前及使用PEEP 30分钟后评估动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）。在纳入其他候选预后因素后，我们评估了使用PEEP时PaO₂/FiO₂的预后价值。根据ARDS的定义，将AE-IPF患者分为重度组（使用PEEP时PaO₂/FiO₂≤300）和非重度组（使用PEEP时PaO₂/FiO₂>300）。

结果

我们连续纳入了62例AE-IPF患者。所有患者在第一天均接受了机械通气治疗。使用PEEP前及使用PEEP 30分钟后的动脉血氧分压/吸入氧分数值中位数显著升高（从237.5升至425.5，P< .001）。在多因素Cox比例分析中，胃泌素释放肽前体（ProGRP）（风险比[HR] 1.239；95%置信区间[CI] 1.050 - 1.461；P = .011）、D-二聚体（HR 1.039；95%CI 1.015 - 1.064；P = .001）、支气管肺泡灌洗液中中性粒细胞百分比（HR 1.015；95%CI 1.003 - 1.027；P = .017）以及属于重度组（HR 3.233；95%CI 1.503 - 6.957；P = .003）对90天内的生存有显著影响。