Ⅱ期肺结节病患者肺功能与影像学进展的性别差异

Gender difference influences progression of patients with stage Ⅱ pulmonary sarcoidosis

关键词:  肺结节病  肺功能  HRCT  预后  进展

Key words:  pulmonary sarcoidosis  pulmonary function  HRCT  prognosis  progression

摘要:

目的探讨Ⅱ期肺结节病患者肺功能和影像学进展的性别差异。方法选取2013—2019年在同济大学附属上海市肺科医院确诊的有完整临床病史记录、实验室检测、HRCT检查和回访记录的184例Ⅱ期肺结节病患者为研究对象，其中女性129例（70.1%），男性55例（29.9%）。收集所有患者第1次入院的病例资料、肺功能检查及影像学数据。由临床医生根据HRCT和随访记录评估患者的进展情况，并记录进展时间。比较男女性肺结节病患者的影像学和肺功能特征；利用自身配对t检验分析两组间12个月（±3个月）肺功能变化的差异；Kaplan-Meier生存分析和Cox风险比例回归模型评估性别和年龄对Ⅱ期肺结节病患者影像学进展的影响。结果184例Ⅱ期肺结节病患者年龄22~76岁，平均年龄（51.5±10.2）岁。男性患者确诊时肺总量（total lung volume, TLC）占预计值百分比(%pred)的数值[93.8%（83.1%~102.7%）]显著低于女性组患者[101.0%（94.4%~110.4%），P<0.001]；Kaplan-Meier生存分析显示，男性1、3、5年的进展率分别为21.8%、63.6%和74.5%，女性1、3、5年的进展率分别为9.3%、27.9%和39.5%，男性Ⅱ期肺结节病患者影像学进展风险高于女性（P=0.021）；≤55岁的男女性患者间差异有统计学意义（P=0.007），但＞55岁的男女性患者间差异无统计学意义（P=0.377）；在女性患者中，＞55岁的患者影像学进展风险也高于≤55岁患者，差异有统计学意义（P=0.041）。Cox比例风险回归模型分析显示，男性是结节病患者影像学进展的危险因素[HR=1.594，95%CI（1.064，2.389），P=0.024]，在将年龄作为混杂变量调整后，性别作为影像学进展的独立危险因素差异更为显著[HR=1.831，95%CI（1.194，2.809），P=0.006]。结论性别是Ⅱ期肺结节病疾病进展的预测指标，男性在1、3、5年影像学的进展率明显高于女性，且在确诊时TLC%pred的数值更低，诊断时病情更为严重。患者性别和年龄可能对判断肺结节病的预后有一定参考价值。

Abstract:

ObjectiveTo investigate the gender difference in lung function and imaging progression in patients with stage Ⅱ pulmonary sarcoidosis. MethodsClinical data of 184 patients with stage Ⅱ pulmonary sarcoidosis， 129 females and 55 males, admitted in Shanghai Pulmonary Hospital from 2013 to 2019 were retrospectively analyzed. The progression of the pulmonary sarcoidosis was assessed based on HRCT imaging and follow-up records. The differences of demographic, imaging, pulmonary function characteristics between male and female patients were compared. Paired comparison was performed for the evaluating changes of lung function; Kaplan-Meier survival analysis and Cox proportional regression model were used to evaluate the effects of gender and age on the progression of the disease. ResultsThe mean age of patients was(51.5 ±10.2) years, ranging from 22 to 76 years. The percentage of total lung volume to estimated value(TLC% PRED) at diagnosis in the male group [93.8%(83.1%-102.7%)] was significantly lower than that in the female group [101.0%(94.4%-110.4%), P<0.001]. No significant difference in baseline HRCT imaging features between male and female groups(P>0.05). The one-year, three-year and five-year progression rates of male group were 21.8%, 63.6%, and 74.5%；and 9.3%, 27.9%, and 39.5% in female group. Additionally, the risk of imaging progression in males was higher than that in females (P=0.021), and the difference was more significantly between genders in patients with ages≤55 years(P=0.007), but not in those >55 years(P=0.377). In women group, the risk of radiographic progression was higher in patients at age≤55 than those at age>55(P=0.041). Cox proportional regression model analysis showed that male gender was an independent risk factor for radiological progression[HR=1.831, 95%CI(1.194, 2.809), P=0.006]. ConclusionDifference of the progression exists between male and female patients with stage Ⅱ pulmonary sarcoidosis. The progression rate of males at 1, 3, and 5 years is significantly higher than that of females, and the value of TLC% PRED in male patients is lower at diagnosis.