日本特发性肺纤维化患者呼吸相关住院的特征及其与生存的关联

Characteristics and association with survival of respiratory-related hospitalization in Japanese idiopathic pulmonary fibrosis patients.

作者信息

Nishiyama Osamu, Saeki Sho, Yamazaki Ryo, Sano Hiroyuki, Iwanaga Takashi, Kume Hiroaki, Tohda Yuji

机构信息

Department of Respiratory Medicine and Allergology, Kindai University, Faculty of Medicine, Osakasayama, Osaka, Japan.

出版信息

Respir Investig. 2019 Sep;57(5):415-421. doi: 10.1016/j.resinv.2019.03.005. Epub 2019 Apr 16.

DOI:10.1016/j.resinv.2019.03.005

PMID:31003952

Abstract

BACKGROUND

The characteristics and significance of respiratory-related hospitalization in patients with idiopathic pulmonary fibrosis (IPF) in Asian countries remain unknown. The purpose of this study was to define the characteristics of respiratory-related hospitalization and to inspect the relationship between respiratory-related hospitalization and subsequent survival in patients with IPF in Japanese general practice.

METHODS

Patients with IPF who underwent clinical evaluation between February 2008 and August 2017 were screened. Only those who had undergone evaluation within 1 year after the diagnosis of IPF were included in the study. The post-diagnosis pulmonary function tests were considered the registration point. We then performed a 6-month landmark analysis including only patients who were alive 6 months after the registration. The characteristics of respiratory-related hospitalizations during the 6 months after registration and the association between respiratory-related hospitalization and survival were investigated.

RESULTS

A total of 106 patients with IPF were included in the study. The mean forced vital capacity (FVC) at registration was 80.2 ± 25.1% predicted. Seventeen patients (16.0%) had respiratory-related hospitalization during the 6 months after registration. Pneumonia was the most frequent reason for hospitalization (47.0%), followed by acute exacerbation of IPF (29.4%). In multivariate analysis, % predicted FVC (hazard ratio: 0.98, 95% confidence interval: 0.96-0.99, p = 0.004), 6-month decrease in % predicted FVC (1.05, 1.02-1.08, 0.005), and respiratory-related hospitalization (2.45, 1.24-4.85, 0.009) were significantly associated with survival.

CONCLUSIONS

Pneumonia is the most frequent cause of respiratory-related hospitalization in Japanese IPF patients. Furthermore, respiratory-related hospitalization is significantly associated with subsequent poor survival.

摘要

背景

在亚洲国家，特发性肺纤维化（IPF）患者呼吸道相关住院治疗的特征和意义尚不清楚。本研究的目的是明确日本普通诊所中IPF患者呼吸道相关住院治疗的特征，并考察呼吸道相关住院治疗与后续生存之间的关系。

方法

筛选2008年2月至2017年8月期间接受临床评估的IPF患者。仅纳入在IPF诊断后1年内接受评估的患者。诊断后的肺功能测试被视为登记点。然后，我们进行了为期6个月的标志性分析，仅纳入登记后6个月存活的患者。调查登记后6个月内呼吸道相关住院治疗的特征以及呼吸道相关住院治疗与生存之间的关联。

结果

本研究共纳入106例IPF患者。登记时的平均用力肺活量（FVC）为预测值的80.2±25.1%。17例患者（16.0%）在登记后6个月内有呼吸道相关住院治疗。肺炎是最常见的住院原因（47.0%），其次是IPF急性加重（29.4%）。在多变量分析中，预测FVC百分比（风险比：0.98，95%置信区间：0.96-0.99，p = 0.004）、预测FVC百分比6个月下降幅度（1.05，1.02-1.08，0.005）以及呼吸道相关住院治疗（2.45，1.24-4.85，0.009）与生存显著相关。