Retrospective Analysis Of Clinical Features Of Idiopathic Pulmonary Fibrosis-related Pulmonary Hypertension

Objective:The clinical data of pulmonary hypertension in patients with IPF were analyzed retrospectively to screen the risk factors of IPF associated PH and improve the prognosis of patients with IPF.Methods:105 patients with IPF who were hospitalized from January 2014 to March 2021 in the department of respiratory and critical care medicine in Jilin University were enrolled in this study.All of patient were divided into IPF-PH group and IPF group.The results of general information,blood routine and blood biochemical indicators,serum Brain natriuretic peptide（BNP）,serum coagulation function,Pulmonary function test and blood gas analysis were compared between the two groups,multivariate logistic regression analysis of risk factors associated with PH were performed.SPSS 22.0statistical software was used to analyze the data.Results:1.PH was found in 36（34.3%）out of 105 patients with IPF.There was no significant difference in general data（including age,gender,smoking and sick time）between the two groups（P>0.05）.There was no significant difference in clinical symptoms（cough,sputum,dyspnea and hemoptysis）and physical signs（finger clubbing,velcro rales）（P>0.05）.2.Compared with that of the IPF group,diffusion capacity of the lung for carbon monoxide(DL_CO)as a Percentage of expected value,（DLco%pred）（P<0.001）,FVC（P=0.005）,FEV₁（P=0.018）were significantly decreased in IPF-PH group（P<0.001）,but there were no significant differences in FVC%pred,FEV₁%pred,FEV₁/FVC and RV/TLC.3.Compared with the IPF group,the levels of BNP（P<0.001）and high-sensitivity CRP（hs-CRP）（P=0.016）in the IPF-PH group were significantly higher than those in the IPF group,there was no significant difference in WBC count,neutrophil（neutrophil）count,red blood cell（RBC）count,platelet（PLT）count,hemoglobin（HB）concentration,uric acid（UA）,alanine transaminase（GPT）,aspartate transaminase（GOT）,lactate dehydrogenase（LDH）,creatinine（Cr）and fasting blood glucose（GLU）between the two groups（P>0.05）.4.Compared with IPF group,D-dimer（P<0.001）and fibrin（Proto）degradation products（P<0.001）in IPF-PH group were significantly higher,there were no statistically differences in prothrombin time（PT）,prothrombin time activity（PTA）,partial thromboplastin time（Activated artial thromboplatin time,APTT）,thrombin time（Trombin time,TT）),Fibrinogen（FIB）,Partial thromboplastin ratio（PTR）and International normal ratio of Prothrombin（INR）between the two groups（P>0.05）.5.Compared with IPF group,Pa O₂（P=0.021）and Sa O₂（P=0.010）in IPF-PH group were significantly lower than those in IPF group,and there were no statistically differences in PH,Pa CO₂,HCO₃^-,BE and lactic acid levels between two groups.（P>0.05）.6.Taking the occurrence of PH as the dependent variable,the variables with P<0.05（FEV₁,DLco%pred,BNP,D-dimer,FDP,hs-CRP,Pa O₂ and Sa O₂）were compared between the two groups.Multivariate logistic regression analysis was performed for the independent variables.The results showed that the decrease of DLco%pred and the increase of BNP are the risk factors for PH in IPF patients.Conclusion:1.Pulmonary hypertension is a common complication of IPF.The incidence of PH in 105 patients with IPF is 34.3%.2.DLco%pred decreased more significantly in patients with IPF and PH.3.BNP Elevation is a predictor of PH in patients with IPF.