A Clinical Study Of Prognosis Of Patients With Idiopathic Pulmonary Fibrosis

[Objective] To investigate prognostic implications of clinical, physiological variables and cellular classification of bronchoalveolar lavage fluid (BALF) in patients with idiopathic pulmonary fibrosis (IPF). Evaluation the effect of treatment with glucocorticoid with or without cytotoxic drugs【Methods】The significances of clinical, arterial blood gas analysis, pulmonary function test, lung high-resolution computed tomography (HRCT), echocardiography and BALF in the prognosis of patients with IPF were assessed in 65 patients with IPF at diagnosis. Univariate and multivariate Cox proportional-hazards regression analysis was used to evaluate various parameters associated with hazard ratio (HR). The survival rates (SRs) of all groups were compared using the Kaplan-Meier method.[Results] In 37.7 months of average follow-up time, SR of IPF patients was 43.1%, and the median survival time was 39 months after diagnosis. The univariate Cox proportional-hazards regression analysis showed that BMI, clubbing fingers, ESR, PaO2/FiO2, SaO2, TLC%, DLco%, pulmonary arterial pressure(PAP) and the percent of neutrophil in BALF were factors that affected the prognosis of patients with IPF. In the meanwhile, the patients were divided into two groups by the median of significant variables in univariate Cox proportional-hazards regression analysis (the cutoff point value), and SR group comparison showed statistically significant difference in BMI, clubbing fingers, ESR, TLC%as well as DLco%(P<0.05), while glucocorticoid with or without cytotoxic drugs for patients with IPF could not change the prognosis. The results of multivariate Cox proportional-hazards regression analysis showed that ESR (Wald=5.11, P=0.024), BMI (Wald=8.21,P=0.004), clubbing fingers(Wald=11.95, P=0.001), TLC%(Wald=15.56, P＜0.001), PAP (Wald=7.43,P=0.006) were factors that affected the prognosis of patients with IPF.[Conclusions] BMI, clubbing fingers, ESR, TLC% and PAP were the main factors affected the prognosis of patients with IPF, glucocorticoid with or without cytotoxic drugs could not change the prognosis of patients with IPF.