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系统性硬化症相关间质性肺疾病肺功能测试严重程度及预后的预测因素

Predictors of lung function test severity and outcome in systemic sclerosis-associated interstitial lung disease.

作者信息

Le Gouellec Noémie, Duhamel Alain, Perez Thierry, Hachulla Anne-Lise, Sobanski Vincent, Faivre Jean-Baptiste, Morell-Dubois Sandrine, Lambert Marc, Hatron Pierre-Yves, Hachulla Eric, Béhal Hélène, Matran Regis, Launay David, Remy-Jardin Martine

机构信息

Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France.

Inserm, U995, Lille, France.

出版信息

PLoS One. 2017 Aug 1;12(8):e0181692. doi: 10.1371/journal.pone.0181692. eCollection 2017.

Abstract

Systemic sclerosis-related interstitial lung disease (SSc-ILD) is the leading cause of death in SSc. In this study, we aimed to describe the baseline severity and evolution of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) in patients with SSc-ILD and to assess the baseline clinical, biological and high-resolution CT scan (HRCT) predictors of this evolution. Baseline and serial FVC and DLCO were collected in 75 SSc-ILD patients followed during 6.4±4.2 years (n = 557 individual data). FVC and DLCO evolution was modelled using a linear mixed model with random effect. During follow-up, FVC was stable while DLCO significantly decreased (-1.5±0.3%/year (p<0.0001). Baseline NYHA functional class III/IV, extensive SSc-ILD on HRCT and DLCO<80% were associated with a lower baseline FVC. Absence of digital ulcers extensive SSc-ILD, and FVC<80% and were associated with a lower baseline DLCO. Presence or history of digital ulcers and presence of pulmonary hypertension at baseline or during follow-up were associated with a faster decline of DLCO overtime. Neither age, gender, subtype of SSc nor specificity of autoantibodies were associated with baseline severity or outcome of lung function tests. In this SSc-ILD population, FVC was therefore stable while DLCO significantly declined over time. ILD extension was associated with baseline FVC and DLCO but not with their evolution. Presence or history of digital ulcers and pulmonary hypertension were predictors of a faster decline of DLCO over time.

摘要

系统性硬化症相关间质性肺疾病(SSc-ILD)是系统性硬化症(SSc)患者的主要死亡原因。在本研究中,我们旨在描述SSc-ILD患者的基线严重程度以及用力肺活量(FVC)和一氧化碳弥散量(DLCO)的变化情况,并评估这种变化的基线临床、生物学和高分辨率CT扫描(HRCT)预测指标。收集了75例SSc-ILD患者的基线及系列FVC和DLCO数据,这些患者接受了6.4±4.2年的随访(共557个个体数据)。使用具有随机效应的线性混合模型对FVC和DLCO的变化进行建模。在随访期间,FVC保持稳定,而DLCO显著下降(-1.5±0.3%/年,p<0.0001)。基线时纽约心脏协会(NYHA)功能分级为III/IV级、HRCT显示广泛的SSc-ILD以及DLCO<80%与较低的基线FVC相关。无指端溃疡、广泛的SSc-ILD以及FVC<80%与较低的基线DLCO相关。指端溃疡的存在或病史以及基线或随访期间存在肺动脉高压与DLCO随时间的更快下降相关。年龄、性别、SSc亚型或自身抗体特异性均与肺功能测试的基线严重程度或结果无关。因此,在这个SSc-ILD人群中,FVC保持稳定,而DLCO随时间显著下降。ILD的范围与基线FVC和DLCO相关,但与它们的变化无关。指端溃疡的存在或病史以及肺动脉高压是DLCO随时间更快下降的预测指标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5929/5538660/928946dd47ab/pone.0181692.g001.jpg

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