Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Respirology. 2018 May;23(5):519-525. doi: 10.1111/resp.13219. Epub 2017 Nov 12.
Pneumothorax is a co-morbidity in patients with idiopathic pulmonary fibrosis (IPF). However, its incidence, risk factors and prognostic significance in IPF remain unclear. The aim of this study was to clarify the incidence and prognostic significance of pneumothorax in patients with IPF, and to further investigate the risk factors for its onset.
Eighty-four consecutive patients with IPF based on the consensus guideline were included in this study. We retrospectively reviewed the medical records, pulmonary function tests and chest high-resolution computed tomography images, and determined the incidence of pneumothorax. The prognostic significance of pneumothorax was evaluated using the Cox proportional hazards model analysis with time-dependent covariates. We also assessed the cumulative incidence and the risk factors for pneumothorax.
Of the 84 patients, 17 (20.2%) developed pneumothorax. The cumulative incidence of pneumothorax was 8.5%, 12.5% and 17.7% at 1, 2 and 3 years, respectively. Univariate analysis demonstrated that pneumothorax was significantly related to poor prognosis (hazards ratio, 2.99; P = 0.002). Multivariate analysis, adjusting for sex, age and forced vital capacity (% predicted), revealed that pneumothorax was an independent predictor of poor outcome in IPF (hazards ratio, 2.85; P = 0.006). Lower BMI and the presence of extensive reticular abnormalities were significantly associated with developing pneumothorax.
These results confirm that patients with IPF often develop pneumothorax during their clinical course and that the onset of pneumothorax predicts a poor outcome.
气胸是特发性肺纤维化（IPF）患者的合并症。然而，其在 IPF 中的发病率、危险因素和预后意义尚不清楚。本研究旨在阐明 IPF 患者气胸的发病率和预后意义，并进一步探讨其发病的危险因素。
本研究纳入了 84 例基于共识指南的 IPF 连续患者。我们回顾性地审查了病历、肺功能检查和胸部高分辨率计算机断层扫描图像，并确定了气胸的发病率。使用具有时间依赖性协变量的 Cox 比例风险模型分析评估气胸的预后意义。我们还评估了气胸的累积发生率和危险因素。
84 例患者中，17 例（20.2%）发生气胸。气胸的累积发病率分别为 1 年、2 年和 3 年时的 8.5%、12.5%和 17.7%。单因素分析表明，气胸与预后不良显著相关（风险比，2.99；P=0.002）。调整性别、年龄和用力肺活量（%预计值）的多因素分析显示，气胸是 IPF 不良结局的独立预测因素（风险比，2.85；P=0.006）。较低的 BMI 和广泛的网状异常存在与气胸的发生显著相关。
这些结果证实，IPF 患者在其临床过程中经常发生气胸，气胸的发生预示着不良结局。
