Objective To explore the influence of mediastinal lymph node enlargement (MLNE) on the expression of matrix metalloproteinase -7 (MMP -7) and survival time of patients with idiopathic pulmonary fibrosis (1PF) . Methods This is a prospective cohort study involved 29 IPF patients. All the patients were diagnosed by two pulmonologists and one radiologist in the First Affiliated Hospital of China Medical University based on the established non - surgical biopsy criteria of 2002 ATS/ ERS. All subjects were divided into two groups: MLNE group (the short axe of at least one mediastinal lymph node ≥1 cm on HRCT) and non - MLNE group (the short axes of all mediastinal lymph nodes < 1 cm on HRCT) . The clinical data of baseline included pulmonary function test, arterial blood gas measurement, analysis of bronchoalveolar lavage fluid (BALF) , and chest HRCT. The concentrations of MMP -7 in serum and BALF were detected by ELISA. Median survival time was calculated. Results The enlarged mediastinal lymph nodes were seen in 13 of 29 patients (44. 8% ) studied. The DLCO% and PaO2 are lower in patients with MLNE than that in those without ( P = 0. 002、0. 036 ) . The concentration of MMP - 7 in serum is higher in patients with MLNE than that in those without (P =0. 010) . The median follow up duration in the study was 24. 3 months. Median survival time was longer in patients without MLNE than in patients with MLNE (38.0 months Vs. 23. 0 months, P <0. 05). Un-ivariate analysis showed that serum MMP - 7 level, smoking, and MLNE were negative prognostic factors ( P = 0. 013, 0. 048, and 0. 010) for IPF. MLNE is negative prognostic factor for IPF [HR=4. 69, 95% CI (1.437, 15.307), P=0.01] .Conclusion The IPF patients with MLNE have higher level of serum MMP - 7 poorer prognosis than the patients without. MLNE is one of the negative prognostic factors for IPF.%目的 评价纵隔淋巴结肿大对特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)患者基质金属蛋白酶-7(matrix metalloproteinase-7,MMP-7)表达及生存率的影响.方法 将29例IPF患者分为纵隔淋巴结肿大组和无纵隔淋巴结肿大组,记录患者确诊时的临床指标,测定血清及支气管肺泡灌洗液(bronchoalveolar larvage fluid,BALF)中MMP-7水平,随访患者的生存情况,绘制Kaplan-Meier生存曲线,进行Log-rank检验.采用Cox多元回归分析影响预后的因素.结果 IPF患者中纵隔淋巴结肿大者占44.8％ (13/29).纵隔淋巴结肿大的IPF患者肺一氧化碳弥散量占预计值百分比(DLCO％)、静息状态动脉血氧分压(PaO2)水平低于无淋巴结肿大者,差异均有统计学意义(P值分别为0.002、0.036)；而血清MMP-7的水平高于无淋巴结肿大者,差异有统计学意义(P =0.010).在平均随访的24.3个月内,伴有纵隔淋巴结肿大IPF患者的中位生存期低于无纵隔淋巴结肿大IPF患者的中位生存期,差异有统计学意义(23.0个月VS.38.0个月,P＜0.05).单因素分析显示血清MMP-7水平、吸烟及纵隔淋巴结肿大是影响IPF患者预后的危险因素(P值分别为0.013、0.048和0.010),Cox多元回归分析显示纵隔淋巴结肿大是影响IPF预后的危险因素[HR =4.69,95％ CI(1.437,15.307),P=0.01].结论 纵隔淋巴结肿大的IPF患者较无纵隔淋巴结肿大的IPF患者血清MMP-7水平增高,而且预后差,纵隔淋巴结肿大是影响IPF患者预后的危险因素之一.
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