Patterson Karen C, Shah Rupal J, Porteous Mary K, Christie Jason D, D'Errico Carly A, Chadwick Matthew, Triano Matthew J, Deshpande Charuhas, Rossman Milton D, Litzky Leslie A, Kreider Maryl, Miller Wallace T
Pulmonary, Allergy & Critical Care Division, University of Pennsylvania, Pennsylvania, PA.
Pulmonary, Critical Care, Allergy and Sleep Medicine Program, University of California, San Francisco, San Francisco, CA.
Chest. 2017 Apr;151(4):838-844. doi: 10.1016/j.chest.2016.11.003. Epub 2016 Nov 16.
Despite the relationship between idiopathic pulmonary fibrosis (IPF) and advancing age, little is known about the epidemiology of interstitial lung disease (ILD) in the elderly. We describe the diagnoses, clinical characteristics, and outcomes of patients who were elderly at the time of ILD diagnosis.
Among subjects from a prospective cohort study of ILD, elderly was defined as age ≥ 70 years. Diagnoses were derived from a multidisciplinary review. Differences between elderly and nonelderly groups were determined using the χ test and analysis of variance.
Of the 327 subjects enrolled, 80 (24%) were elderly. The majority of elderly subjects were white men. The most common diagnoses were unclassifiable ILD (45%), IPF (34%), connective tissue disease (CTD)-ILD (11%), and hypersensitivity pneumonitis (8%). Most elderly subjects (74%) with unclassifiable ILD had an imaging pattern inconsistent with usual interstitial pneumonia (UIP). There were no significant differences in pulmonary function or 3-year mortality between nonelderly and elderly subjects combined or in a subgroup analysis of those with IPF.
Although IPF was the single most common diagnosis, the majority of elderly subjects had non-IPF ILD. Our findings highlight the need for every patient with new-onset ILD, regardless of age, to be surveyed for exposures and findings of CTD. Unclassifiable ILD was common among the elderly, but for most, the radiographic pattern was inconsistent with UIP. Although the effect of ILD may be more pronounced in the elderly due to reduced global functionality, ILD was not more severe or aggressive in this group.
尽管特发性肺纤维化（IPF）与年龄增长有关，但对于老年人间质性肺疾病（ILD）的流行病学了解甚少。我们描述了在ILD诊断时已属老年患者的诊断情况、临床特征及转归。
在一项ILD前瞻性队列研究的受试者中，将年龄≥70岁定义为老年。诊断源自多学科评估。采用χ检验和方差分析确定老年组与非老年组之间的差异。
在纳入的327名受试者中，80名（24%）为老年人。大多数老年受试者为白人男性。最常见的诊断为无法分类的ILD（45%）、IPF（34%）、结缔组织病（CTD）-ILD（11%）和过敏性肺炎（8%）。大多数无法分类的ILD老年受试者（74%）的影像学表现与普通型间质性肺炎（UIP）不一致。非老年组与老年组合并分析或IPF患者亚组分析中，肺功能或3年死亡率无显著差异。
尽管IPF是最常见的单一诊断，但大多数老年受试者患有非IPF-ILD。我们的研究结果强调，对于每一位新发ILD患者，无论年龄大小，都需要调查其CTD的暴露情况和发现。无法分类的ILD在老年人中很常见，但对大多数人来说，影像学表现与UIP不一致。尽管由于整体功能下降，ILD在老年人中的影响可能更明显，但该组中ILD并不更严重或更具侵袭性。
