| Objective: To discuss and analyze clinical manifestations, pulmonaryfunctions, imaging characteristics and so forth in patients with combinedpulmonary fibrosis and emphysema (CPFE) in order to deepen the domesticdoctor’s understanding of the disease.Methods: In this study,35cases of patients whose imagingmanifestations were in line with CPFE collected in the ward of Department ofRespiratory Medicine in the Norman Bethune first Hospital of Jilin Universityfrom January1,2011to December31,2012were analyzed with regard toclinical features, medical records, pulmonary functions and chest HRCT andetc.Results: In35cases of patients,32cases were male, and3female, aged65±10years including27elderly people (age>60years)(77.1%);27cases(77.1%) had a long history of smoking with a smoking index (the number ofcigarets consumed eachday times the number of years of smoking) of100~ 1800pack-year.21cases (60%) had post-activity difficult breathing;24cases(68.5%) had cough;23cases (65.7%) had cough and sputum;2cases (5.7%)had hemoptysis;3cases (8.6%) had chest tightness and pain;8cases (22.9%)had a fever;24cases (68.6%) had inspiratory crackles in the lower side of bothlungs;8cases (22.9%) had scattered moist rale in both lungs;8cases (22.9%)had scattered rhonchi in both lungs;9cases (25.7%) had no significantpulmonary signs. In26patients completing lung function inspections:14cases(53.8%) had mixed ventilation dysfunction,6cases (23.1%) obstructiveventilatory dysfunction,5cases (19.2%) restrictive ventilatory dysfunction, and2cases (7.7%) normal ventilation function;26cases (100%) had diffusedysfunction, including2cases of patients with such poor condition that theirinspection discontinued and with dispersion function so severely decreased thatthe data couldn’t measured. Lung function results (mean±standard deviation):forced expiratory volume in one second (FEV1) was (63±25)%of expectedvalue, forced expiratory volume in one second/forced vital capacity(FEV1/FVC) was0.77±0.10, forced vital capacity (FVC) was (67±14)%ofexpected value, and vital capacity (VC) was (68±16)%of expected value, total lung capacity (TLC) was (80±9)%of expected value, residual volume (RV)was (84±24)%of expected value, and carbon monoxide diffusion capacity(Dlco) was (38±10)%of expected value. All of35cases being subject to HRCT:14cases (40%) had centrilobular emphysema,30cases (85.7%) paraseptalemphysema,2cases (5.7%) panlobular emphysema,5cases (14.8%)pulmonary bulla. The interstitial change in the lower side of both lungs oftenoccurred in subpleural regions, including grid-like shadow in20cases (57.1%),honeycomb-like shadow10cases (28.6%), ground-glass shadow19cases(54.3%) and traction bronchiectasis4cases (11.4%).10cases showed chronicbronchitis combined with interstitial change.31cases underwent this examincluding26cases with hypoxemia but not accompanied by hypercapnia. PaO2was (69±13) mmHg and PaCO2(37±5) mmHg.23cases completed theechocardiography, including21cases (91.3%) with diseased left ventriculardiastolic function,4cases (17.4%) left atrium and left ventricular enlargement,3cases (13.0%) right atrium and right ventricular enlargement,8cases (34.8%)pulmonary arterial hypertension.Conclusion: 1. CPFE patients differ from those with pure COPD and IPF in suchaspects as imaging, pulmonary function, echocardiography and etc.2. HRCT on CPFE patients showed paraseptal emphysema dominated,lung volume was relatively normal and dispersion function decreasedsignificantly.3. HRCT on CPFE patients showed that grid-like and ground glassshadows dominated in pulmonary fibrosis.4. CPFE patients were found mainly with mild-to-moderate hybridventilation dysfunction and decreased left ventricular diastolic function. |
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