Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Japan.
Mod Rheumatol. 2021 Nov;31(6):1100-1106. doi: 10.1080/14397595.2021.1879346. Epub 2021 Feb 25.
This study evaluated the prognostic factors for acute exacerbation (AE), including sequential changes in Krebs von den Lungen-6 (KL-6) levels, in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) patients.
This was a retrospective observational study. We reviewed 125 patients diagnosed with RA-ILD between 2010 and 2019. We defined ΔKL-6 as the annual variation rate of KL-6 one visit before AE onset (or the last visit). The Cox regression analysis was used for evaluating significant variables associated with AE. We analysed the overall survival and respiratory-related death-free survival.
Thirty-three patients (26.4%) developed AE during the observation period. The univariate analysis revealed that KL-6 levels at RA-ILD diagnosis [hazard ratio (HR), 1.11; 95% confidence interval (CI), 1.05-1.15; < .01) and ΔKL-6 (HR: 3.69; 95% CI: -1.36 to 7.96; .01] were significantly associated with AE. ΔKL-6 was an independent prognostic factor for AE in the multivariate analysis (HR: 3.37; 95% CI: -1.16 to 8.87; .03). Patients with AE had a significantly higher overall mortality rate ( .02) and respiratory-related mortality rate ( .01) than those without AE.
ΔKL-6 can be a prognostic marker for detecting AE in RA-ILD patients.
本研究评估了类风湿关节炎相关间质性肺病（RA-ILD）患者急性加重（AE）的预后因素，包括 Krebs von den Lungen-6（KL-6）水平的连续变化。
这是一项回顾性观察性研究。我们回顾了 2010 年至 2019 年间诊断为 RA-ILD 的 125 名患者。我们将 ΔKL-6 定义为 AE 发病前一次就诊（或最后一次就诊）的 KL-6 年变化率。采用 Cox 回归分析评估与 AE 相关的显著变量。我们分析了总生存率和呼吸相关无死亡生存率。
在观察期间，33 名患者（26.4%）发生 AE。单因素分析显示，RA-ILD 诊断时的 KL-6 水平[风险比（HR），1.11；95%置信区间（CI），1.05-1.15； < .01]和 ΔKL-6（HR：3.69；95% CI：-1.36 至 7.96； .01）与 AE 显著相关。ΔKL-6 是多变量分析中 AE 的独立预后因素（HR：3.37；95% CI：-1.16 至 8.87； .03）。AE 患者的总死亡率（ .02）和呼吸相关死亡率（ .01）显著高于无 AE 患者。
ΔKL-6 可作为检测 RA-ILD 患者 AE 的预后标志物。
