Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Health, Denver, CO.
Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Health, Denver, CO.
Chest. 2013 Nov;144(5):1644-1651. doi: 10.1378/chest.12-2685.
The cornerstone of hypersensitivity pneumonitis (HP) management is having patients avoid the inciting antigen (IA). Often, despite an exhaustive search, an IA cannot be found. The objective of this study was to examine whether identifying the IA impacts survival in patients with chronic HP.
We used the Kaplan-Meier method to display, and the log-rank test to compare, survival curves of patients with well-characterized chronic HP stratified on identification of an IA exposure. A Cox proportional hazards (PH) model was used to identify independent predictors in time-to-death analysis.
Of 142 patients, 67 (47%) had an identified IA, and 75 (53%) had an unidentified IA. Compared with survivors, patients who died (n = 80, 56%) were older, more likely to have smoked, had lower total lung capacity % predicted and FVC % predicted, had higher severity of dyspnea, were more likely to have pulmonary fibrosis, and were less likely to have an identifiable IA. In a Cox PH model, the inability to identify an IA (hazard ratio [HR], 1.76; 95% CI, 1.01-3.07), older age (HR, 1.04; 95% CI, 1.01-1.07), the presences of pulmonary fibrosis (HR, 2.43; 95% CI, 1.36-4.35), a lower FVC% (HR, 1.36; 95% CI, 1.10-1.68), and a history of smoking (HR, 2.01; 95% C1, 1.15-3.50) were independent predictors of shorter survival. After adjusting for mean age, presence of fibrosis, mean FVC%, mean diffusing capacity of the lung for carbon monoxide (%), and history of smoking, survival was longer for patients with an identified IA exposure than those with an unidentified IA exposure (median, 8.75 years vs 4.88 years; P = .047).
Among patients with chronic HP, when adjusting for a number of potentially influential predictors, including the presence of fibrosis, the inability to identify an IA was independently associated with shortened survival.
过敏性肺炎（HP）管理的基石是让患者避免接触激发抗原（IA）。尽管进行了详尽的搜索，但通常仍无法找到 IA。本研究的目的是检查识别 IA 是否会影响慢性 HP 患者的生存。
我们使用 Kaplan-Meier 方法显示，并使用对数秩检验比较了根据 IA 暴露情况对特征明确的慢性 HP 患者进行分层的生存曲线。使用 Cox 比例风险（PH）模型对死亡时间分析中的独立预测因素进行识别。
在 142 名患者中，67 名（47%）有明确的 IA，75 名（53%）有未明确的 IA。与幸存者相比，死亡患者（n = 80，56%）年龄更大，更有可能吸烟，总肺活量%预测值和 FVC%预测值更低，呼吸困难程度更高，更有可能患有肺纤维化，并且不太可能确定 IA。在 Cox PH 模型中，无法确定 IA（危险比 [HR]，1.76；95%CI，1.01-3.07）、年龄较大（HR，1.04；95%CI，1.01-1.07）、存在肺纤维化（HR，2.43；95%CI，1.36-4.35）、FVC%较低（HR，1.36；95%CI，1.10-1.68）和吸烟史（HR，2.01；95%CI，1.15-3.50）是生存时间较短的独立预测因素。在调整平均年龄、纤维化存在、平均 FVC%、平均一氧化碳肺弥散量（%）和吸烟史后，与未识别 IA 暴露的患者相比，有明确 IA 暴露的患者生存时间更长（中位数，8.75 年与 4.88 年；P =.047）。
在慢性 HP 患者中，在调整了许多潜在的影响预测因素后，包括纤维化的存在，无法识别 IA 与缩短生存时间独立相关。
