Clinical Study Of Prognostic Related Indexes In Patients With Idiopathic Pulmonary Fibrosis

Background and ObjectiveIdiopathic pulmonary fibrosis(IPF)has an insidious and complex onset,and the pathogenesis has not been fully elucidated.The current treatment plan is still based on drug therapy,although it can improve the patient's symptoms to a certain extent and delay the progress of IPF.However,many patients have a poor prognosis and a high mortality rate.Mastering the general course of IPF and understanding its prognosis are important for the formulation of treatment plans and the development of new drugs.At present,there is no unified conclusion about the research on the prognostic indicators of IPF at home and abroad.Clinical parameters,serological markers,blood gas,pulmonary function,pulmonary arterial pressure(PAP)and other indicators are economically and convenient to detect clinically.Therefore,this study aims to further explore the significance of the above-mentioned clinical indicators of IPF in the prognostic evaluation and to Provide reference for clinical work.Materials and MethodsWe retrospectively selected 126 patients with IPF from January 2014 to January 2017 in the Respiratory Department of the Second Affiliated Hospital of Zhengzhou University.We Collected the general information of the patients(sex,age,height,weight and whether there are underlying diseases,etc.),calculated the Body Mass Index(BMI).We Collected test indicators[including fibrinogen(FBG),D-dimer(D-D)and other coagulation-related parameters,Red Cell volume Distribution Width(RDW),Prealbumin(PA)];The results of arterial blood gas analysis including partial pressure of oxygen(PaO2),calculated the oxygenation index(PaO2/FiO2)after correcting the oxygen inhalation state;The Lung function parameters including Total lung volume(TLC),Carbon monoxide diffusing capacity(DLCO),Forced vital capacity(FVC),etc;PAP value measured by doppler echocardiography;treatment options for patients with IPF[including N-acetylcysteine(NAC)alone;NAC combined with glucocorticoids;Symptomatic supportive therapy].Patients' survival status since admission was followed up regularly by outpatient or telephone visits.The Cox proportional risk regression model was used to detect the harzard ratio(HR)of each index and the Kaplan-Meier test were used to compare the survival rates between groups.The predictive value of each index on the prognosis of patients with IPF was analyzed by plotting the survival curve.ResultsThe patients with IPF were followed up 35.86±12.54 months on average and the overall survival rate was 46.51%.The median survival time after diagnosis was 43 months.The results of univariate cox proportional risk regression analysis showed that BMI,FBG,D-D,RDW,PA,PaO2,PaO2/FiO2,DLCO%,TLC%,and PAP were the influencing factors for patients' prognosis(P<0.05).However,the clinical factors such as age,gender,smoking and treatment status was not related to the prognosis of patients with IPF(P>0.05).The median of the significant variables of the univariate proportional hazard regression was used as the cutoff value to divide the patients into two groups and the survival rate was compared between Kaplan-Meier groups.The results showed that the survival rates among BMI,FBG,D-D,RDW,PA,PaO2,PaO2/FiO2,DLCO%,TLC%and PAP groups were statistically significant(P<0.05).After diagnosis,the survival rate of patients treated with NAC alone or glucocorticoid combined was insignificant(P>0.05).The multivariate cox proportional hazard regression analysis results showed that BMI(HR=0.818,Wald=5.786,P=0.016),FBG(HR=1.885,Wald=8,924,P=0.003),PA(HR=0.988,Wald=4.431,P=0.035),DLCO%(HR=0.969,Wald=4.346,P=0.037),and PAP(HR=1.038,Wald=4.210,P=0.040)were the related factors affecting the prognosis of patients(P<0.05).The HR values of BMI,PA,and DLCO%were all less than one,which were positively correlated with the prognosis of patients with IPF.The HR values of FBG,PAP were greater than one,which were negatively correlated with the prognosis of IPF,and they were prognostic risk factors for patients with IPF.Conclusions1.BMI,FBG,PA,DLCO%,and PAP have reference values for the survival prognosis of patients with IPF,and are expected to be early indicators for predicting the prognosis of patients with IPF.2.NAC alone or combined with glucocorticoid therapy has no significant effect on the prognosis of patients with IPF.