Analysis of the clinical characteristics of interstitial lung disease complicated by pneumothorax and hystitial diastinum

doi:10.3877/cma.j.issn.1674-6902.2024.01.011

Abstract

Abstract:

Objective

To analyze the clinical characteristics of patients with interstitial lung disease (ILD) complicated with pneumothorax and mediastinal emphysema.

Methods

The clinical data of 36 ILD patients with pneumothorax and mediastinal emphysema diagnosed and treated in the respiratory department of our hospital from November, 2011 to August, 2022 were retrospectively analyzed, the clinical characteristics of this population were described, and the outcome was analyzed.

Results

There were 20 patients with pneumothorax and 16 patients with mediastinal emphysema. IPF accounted for the highest proportion of the two types of patients, 8 cases (40.00%) and 4 cases (25.00%), respectively. Other ILD types include: idiopathic pleuroparenchymal fibroelastosis(iPPFE), idiopathic non-specific interstitial pneumonia(iNSIP), interstitial pneumonia with autoimmune features(IPAF), dermatomyositis interstitial lung disease(DM-ILD), rheumatoid interstitial lung disease(RA-ILD), microscopic polyvasculitis interstitial lung disease(MPA-ILD), pulmonary alveolar proteinosis(PAP), chemotherapy related interstitial lung disease, cryptogenic organizing pneumonia(COP). usual interstitial pneumonia(UIP) and NSIP were the main imaging types. The patients had cough symptoms. They were complicated with emphysema, pulmonary bullae, pulmonary heart disease, pleural effusion, infection, etc. Some patients also had ILD exacerbation or acute exacerbation of ILD(AE-ILD). Among the patients who died, the proportion of patients with ILD exacerbation, AE-ILD, ventilator treatment during hospitalization and glucocorticoid treatment before onset was higher (P<0.05), and the proportion of patients with pneumothorax and mediastinal emphysema who developed AE-ILD was higher (P<0.05).

Conclusion

Pneumothorax and mediastinal emphysema are both of the complications of ILD. They can affect the prognosis of patients with ILD, and should be actively prevented. When patients with ILD have increased dyspnea, chest pain, decreased oxygenation and other conditions, it is necessary to actively improve the relevant examination, and be alert to the occurrence of pneumothorax and mediastinal emphysema.

Key words: Interstitial lung disease, Pneumothorax, Mediastinal emphysema, Clinical features

Liya Guo, Yiqing Jiao, Youran Lu, Yanan Wang, Zongxue Zhang, Jian Liu, Yuguang Wang. Analysis of the clinical characteristics of interstitial lung disease complicated by pneumothorax and hystitial diastinum[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 57-62.

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References 30

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临床资料	气胸(n＝20)			纵隔气肿(n＝16)
临床资料	好转	死亡	P值	好转	死亡	P值
性别
男	8(72.73)	3(27.27)	1.000	6(85.71)	1(14.29)	1.000
女	7(77.78)	2(22.22)		8(88.89)	1(11.11)
气胸
单侧	10(66.67)	5(33.33)	0.266	0(0.00)	0(0.00)	0.000
双侧	5(100.00)	0(0.00)		0(0.00)	0(0.00)
肺压缩体积						0.000
<30%	12(85.71)	2(14.29)	0.131	4(100.00)	0(0.00)
>30%	3(50.00)	3(50.00)		－	－
小叶中心肺气肿^a	10(100.00)	0(0.00)	0.033	7(100.00)	0(0.00)	0.475
间质性肺气肿	12(80.00)	3(20.00)	0.560	13(92.86)	1(7.14)	0.242
ILD加重^a	5(50.00)	5(50.00)	0.033	11(84.62)	2(15.38)	1.000
皮下气肿	2(50.00)	2(50.00)	0.249	4(100.00)	0(0.00)	1.000
吸烟史	6(75.00)	2(25.00)	1.000	4(80.00)	1(20.00)	1.000
细菌感染	12(70.59)	5(29.41)	0.539	7(77.78)	2(22.22)	0.475
真菌感染	4(50.00)	4(50.00)	0.539	4(100.00)	0(0.00)	1.000
肺心病	4(57.14)	3(42.86)	0.290	5(83.33)	1(16.67)	1.000
应用呼吸机治疗^a	0(0.00)	4(100.00)	0.001	0(0.00)	0(0.00)	0.000
既往应用激素治疗^a	5(50.00)	5(50.00)	0.033	8(80.00)	2(20.00)	0.500
存在AE-ILD^a	0(0.00)	5(100.00)	0.000	1(33.33)	2(66.67)	0.025
诊断ILD到发生气胸/纵隔气肿时间(年)	2.74±2.43	6.42±6.56	0.075	2.86±2.31	1.04±1.36	0.303
氧合指数(mmHg)^a	313.60±93.47	170.60±42.77	0.004	341.38±83.59	186.00±33.94	0.025

临床资料	气胸(n＝20)			纵隔气肿(n＝16)
临床资料	好转	死亡	P值	好转	死亡	P值
性别
男	8(72.73)	3(27.27)	1.000	6(85.71)	1(14.29)	1.000
女	7(77.78)	2(22.22)		8(88.89)	1(11.11)
气胸
单侧	10(66.67)	5(33.33)	0.266	0(0.00)	0(0.00)	0.000
双侧	5(100.00)	0(0.00)		0(0.00)	0(0.00)
肺压缩体积						0.000
<30%	12(85.71)	2(14.29)	0.131	4(100.00)	0(0.00)
>30%	3(50.00)	3(50.00)		－	－
小叶中心肺气肿^a	10(100.00)	0(0.00)	0.033	7(100.00)	0(0.00)	0.475
间质性肺气肿	12(80.00)	3(20.00)	0.560	13(92.86)	1(7.14)	0.242
ILD加重^a	5(50.00)	5(50.00)	0.033	11(84.62)	2(15.38)	1.000
皮下气肿	2(50.00)	2(50.00)	0.249	4(100.00)	0(0.00)	1.000
吸烟史	6(75.00)	2(25.00)	1.000	4(80.00)	1(20.00)	1.000
细菌感染	12(70.59)	5(29.41)	0.539	7(77.78)	2(22.22)	0.475
真菌感染	4(50.00)	4(50.00)	0.539	4(100.00)	0(0.00)	1.000
肺心病	4(57.14)	3(42.86)	0.290	5(83.33)	1(16.67)	1.000
应用呼吸机治疗^a	0(0.00)	4(100.00)	0.001	0(0.00)	0(0.00)	0.000
既往应用激素治疗^a	5(50.00)	5(50.00)	0.033	8(80.00)	2(20.00)	0.500
存在AE-ILD^a	0(0.00)	5(100.00)	0.000	1(33.33)	2(66.67)	0.025
诊断ILD到发生气胸/纵隔气肿时间(年)	2.74±2.43	6.42±6.56	0.075	2.86±2.31	1.04±1.36	0.303
氧合指数(mmHg)^a	313.60±93.47	170.60±42.77	0.004	341.38±83.59	186.00±33.94	0.025

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