Dept of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
Faculty of Medicine, University of Sydney, Sydney, Australia.
Eur Respir J. 2017 Feb 23;49(2). doi: 10.1183/13993003.01592-2016. Print 2017 Feb.
7The prevalence of idiopathic pulmonary fibrosis (IPF), a fatal and progressive lung disease, is estimated at 1.25-63 out of 100 000, making large population studies difficult. Recently, the need for large longitudinal registries to study IPF has been recognised.The Australian IPF Registry (AIPFR) is a national registry collating comprehensive longitudinal data of IPF patients across Australia. We explored the characteristics of this IPF cohort and the effect of demographic and physiological parameters and specific management on mortality.Participants in the AIPFR (n=647, mean age 70.9±8.5 years, 67.7% male, median follow up 2 years, range 6 months-4.5 years) displayed a wide range of age, disease severity and co-morbidities that is not present in clinical trial cohorts. The cumulative mortality rate in year one, two, three and four was 5%, 24%, 37% and 44% respectively. Baseline lung function (forced vital capacity, diffusing capacity of the lung for carbon monoxide, composite physiological index) and GAP (gender, age, physiology) stage (hazard ratio 4.64, 95% CI 3.33-6.47, p<0.001) were strong predictors of mortality. Patients receiving anti-fibrotic medications had better survival (hazard ratio 0.56, 95% CI 0.34-0.92, p=0.022) than those not on anti-fibrotic medications, independent of underlying disease severity.The AIPFR provides important insights into the understanding of the natural history and clinical management of IPF.
7 特发性肺纤维化 (IPF) 的患病率估计为每 10 万人中有 1.25-63 人,这使得进行大规模人群研究变得困难。最近,人们认识到需要大型纵向登记处来研究特发性肺纤维化。澳大利亚特发性肺纤维化登记处 (AIPFR) 是一个全国性的登记处,汇集了澳大利亚各地特发性肺纤维化患者的全面纵向数据。我们探讨了这一特发性肺纤维化队列的特征,以及人口统计学和生理学参数以及特定管理对死亡率的影响。
AIPFR(n=647,平均年龄 70.9±8.5 岁,67.7%为男性,中位随访时间为 2 年,范围为 6 个月-4.5 年)的参与者表现出广泛的年龄、疾病严重程度和合并症,这在临床试验队列中并不存在。第一年、第二年、第三年和第四年的累积死亡率分别为 5%、24%、37%和 44%。基线肺功能(用力肺活量、一氧化碳弥散量、综合生理指数)和 GAP(性别、年龄、生理学)分期(危险比 4.64,95%CI 3.33-6.47,p<0.001)是死亡率的强有力预测因素。接受抗纤维化药物治疗的患者比未接受抗纤维化药物治疗的患者生存率更好(危险比 0.56,95%CI 0.34-0.92,p=0.022),这与潜在疾病严重程度无关。
AIPFR 为理解特发性肺纤维化的自然史和临床管理提供了重要的见解。