特发性肺纤维化患者接触职业性粉尘的抗纤维化治疗反应和预后预测因子。

Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust.

机构信息

Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64, Ferrara, Italy.

Center for Rare Lung Diseases, University Hospital of Modena, Via del Pozzo 71, Modena, Italy.

出版信息

BMC Pulm Med. 2019 Sep 5;19(1):170. doi: 10.1186/s12890-019-0930-7.

DOI:10.1186/s12890-019-0930-7

PMID:31488107

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6727559/

Abstract

BACKGROUND

Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. We evaluated clinical characteristics, respiratory function and prognostic predictors at diagnosis and at 12 month treatment of pirfenidone or nintedanib in IPF patients according to occupational dust exposure.

METHODS

A total of 115 IPF patients were recruited. At diagnosis, we collected demographic, clinical characteristics, occupational history. Pulmonary function tests were performed and two prognostic indices [Gender, Age, Physiology (GAP) and Composite Physiologic Index (CPI)] calculated, both at diagnosis and after the 12 month treatment. The date of long-term oxygen therapy (LTOT) initiation was recorded during the entire follow-up (mean = 37.85, range 12-60 months).

RESULTS

At baseline, patients exposed to occupational dust [≥ 10 years (n = 62)] showed a lower percentage of graduates (19.3% vs 54.7%; p = 0.04) and a higher percentage of asbestos exposure (46.8% vs 18.9%; p 0.002) than patients not exposed [< 10 years (n = 53)]. Both at diagnosis and after 12 months of antifibrotics, no significant differences for respiratory function and prognostic predictors were found. The multivariate analysis confirmed that occupational dust exposure did not affect neither FVC and DLCO after 12 month therapy nor the timing of LTOT initiation.

CONCLUSION

Occupational dust exposure lasting 10 years or more does not seem to influence the therapeutic effects of antifibrotics and the prognostic predictors in patients with IPF.

摘要

背景

特发性肺纤维化（IPF）是一种具有不可预测病程的侵袭性肺间质疾病。职业性粉尘暴露可能导致 IPF 的发病，但它对抗纤维化治疗和疾病预后的影响尚不清楚。我们根据职业性粉尘暴露情况，评估了 IPF 患者吡非尼酮或尼达尼布治疗 12 个月时的临床特征、呼吸功能和预后预测因素。

方法

共纳入 115 名 IPF 患者。在诊断时，我们收集了人口统计学、临床特征和职业史。进行了肺功能检查，并计算了两个预后指数[性别、年龄、生理学（GAP）和综合生理学指数（CPI）]，均在诊断时和 12 个月治疗后进行。整个随访期间（平均为 37.85 个月，范围为 12-60 个月）记录了长期氧疗（LTOT）的起始日期。

结果

在基线时，暴露于职业性粉尘[≥ 10 年（n = 62）]的患者中，毕业生的比例较低（19.3% vs 54.7%；p = 0.04），而暴露于石棉的比例较高（46.8% vs 18.9%；p 0.002）。在诊断时和接受抗纤维化治疗 12 个月后，两组间的呼吸功能和预后预测因素均无显著差异。多变量分析证实，职业性粉尘暴露持续 10 年或以上，既不影响 12 个月治疗后 FVC 和 DLCO，也不影响 LTOT 起始时间。