Clinical Analysis Of56Cases Of Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Interstitial Fibrosis

COPD and pulmonary interstitial fibrosis are two types of diseases thatboth have high morbidity and mortality in elderly patients, which have obviousdifference in clinical manifestations, imaging findings and pathological aspectsand used to be think that they cannot coexist. With the deep research in COPDand the wide using of chest HRCT, we found that COPD can coexist withpulmonary interstitial fibrosis and once appear, patients have frequentexacerbations episodes, serious influenced quality of life and prognosis andincreased fatality rate. Therefore, it is important to deepen cliniciansunderstanding of the causes, clinical characteristics and diagnostic criteria ofCOPD complicated with pulmonary interstitial fibrosis, which can prevent thehappening of the disease, timely diagnose and treat, improve the quality ofpatients and reduce the case fatality rate.Objective:By investigating the causes, clinical characteristics and diagnostic criteriaof COPD complicated with pulmonary interstitial fibrosis, to deepen cliniciansunderstanding of the disease; to study the significance of serum KL-6testing inthe diagnosis of COPD complicated with pulmonary interstitial fibrosis.Methods:56cases of patients with COPD complicated with pulmonary interstitialfibrosis and50cases of patients with COPD selected in the ward of Departmentof Respiratory Medicine in the First Clinical Hospital of Jilin Universitybetween January2013and January2015were compared with regard to the age,disease course, smoking index, syndrome, signs, blood gas analysis, lungfunction, serum KL-6levels, pulmonary artery systolic pressure, chest HRCT and etc.Results:1.Compared with the COPD group,the COPD complicated withpulmonary interstitial fibrosis group had older patients,longer course and highersmoking index, however the difference was not statistical significantly(P＞0.05).2.Compared with the COPD group, the COPD complicated withpulmonary interstitial fibrosis group with Velcro rales and clubbing fingerswere higher, and had severer dyspnea, the difference was statisticalsignificantly (P＜0.05).3.Two groups all had different degree of hypoxemia, the PaO2levelof the COPD complicated with pulmonary interstitial fibrosis group droppedmore apparent, the difference was statistical significantly (P＜0.05); twogroups all had different levels of carbon dioxide retention, and the carbondioxide retention of the COPD group was more obvious, the differencewas statistical significantly (P＜0.05).4.The lung function of ventilation (FEV1%pred, FVC%pred, FEV1／FVC%) of two groups had different degree of decline, and the COPDcomplicated with pulmonary interstitial fibrosis group showed FVC%predmore lower (P＜0.05); the volume (TLC%pred) of two groups had differentdegree of decline, however the difference was not statistical significantly (P＞0.05); the volume (RV/TLC) of two groups increased to different extent,and the COPD group increased more obviously; the diffusion（DLCO%pred）of two groups all had declined, and the COPD complicated with pulmonaryinterstitial fibrosis group declined more obviously(P＜0.05).5.Compared with the COPD group, the serum level of KL-6of COPDcomplicated with pulmonary interstitial fibrosis group was significantly higher(P＜0.05), And the serum level of KL-6was negatively correlated withDLCO%pred and had no significantly collection with FEV1%pred、FVC%predand FEV1/FVC.6.Compared with the COPD group, the chest HRCT findings in patientswith COPD complicated with pulmonary interstitial fibrosis group showed thecharacteristics of pulmonary interstitial fibrosis on the basis of emphysema.7.Compared with the COPD group, the incidence and degree of pulmonaryhypertension in the COPD complicated with pulmonary interstitial fibrosisgroup was higher, the difference was statistical significantly (P＜0.05).Conclusion:1.The COPD patients can merge pulmonary interstitial fibrosis, that haveunique clinical、laboratory、lung function and imaging manifestation. Whenthere is intractable dyspnea and hypoxemia in COPD patients inconsistent withcondition are important clues to diagnosis. And chest HRCT is the best way ofclinical diagnosis.2.The elevated level of serum KL-6can help in diagnosing COPDcomplicated with pulmonary interstitial fibrosis, but its diagnostic specificityand sensitivity is not clear, that need more research.