类风湿关节炎相关间质性肺疾病的死亡率：影像学模式的作用。

Mortality rate in rheumatoid arthritis-related interstitial lung disease: the role of radiographic patterns.

机构信息

Pneumology Department Hospital Clínico San Carlos, Madrid, Spain.

Universidad Complutense, Madrid, Spain.

出版信息

BMC Pulm Med. 2021 Jun 30;21(1):205. doi: 10.1186/s12890-021-01569-5.

DOI:10.1186/s12890-021-01569-5

PMID:34193085

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8243533/

Abstract

BACKGROUND

To assess mortality rate (MR) and standardized mortality rate (SMR) of rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients and to evaluate the role of radiographic patterns in mortality.

METHODS

A longitudinal multicentric study was conducted in RA-ILD patients from 2005 to 2015 and followed-up until October 2018 in Madrid. Patients were included in the Neumologia-Reumatología y Enfermedades Autoinmunes Registry, from diagnosis of ILD. The main outcome was all-cause mortality. The radiographic pattern at baseline [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), or others] was the independent variable. Covariables included sociodemographic and clinical data. Survival techniques were used to estimate MR, expressed per 1000 persons-year with their 95% confidence intervals [CI]. Cox multiple regression model was run to examine the influence of radiographic patterns on survival. SMR [CI] was calculated comparing MR obtained with MR expected in the general population of Madrid by indirect age-gender standardization.

RESULTS

47 patients were included with a follow-up 242 patients-year. There were 16 (34%) deaths, and most frequent causes were acute ILD exacerbation and pneumonia. MR was 64.3 [39.4-104.9], and 50% of the patients died at 8.3 years from ILD diagnosis. After adjusting for confounders, (UIP compared to NSIP was associated with higher mortality risk. The overall SMR was 2.57 [1.4-4.17]. Women of 60-75 years of age were the group with the highest SMR.

CONCLUSIONS

RA-ILD is associated with an excess of mortality compared to general population. Our results support that UIP increases the risk of mortality in RA-ILD, regardless other factors.

摘要

背景

评估类风湿关节炎相关间质性肺病（RA-ILD）患者的死亡率（MR）和标准化死亡率（SMR），并评估影像学模式在死亡率中的作用。

方法

对 2005 年至 2015 年间马德里 2 个中心的 RA-ILD 患者进行了一项纵向多中心研究，并随访至 2018 年 10 月。患者从ILD 诊断时开始纳入 Neumologia-Reumatología y Enfermedades Autoinmunes 登记处。主要结局为全因死亡率。基线时的影像学模式[普通间质性肺炎（UIP）、非特异性间质性肺炎（NSIP）或其他]为自变量。协变量包括社会人口统计学和临床数据。生存技术用于估计 MR，以每 1000 人年表示，并给出 95%置信区间[CI]。Cox 多因素回归模型用于检查影像学模式对生存的影响。通过间接年龄性别标准化，将 RA-ILD 患者的 MR 与马德里一般人群的预期 MR 进行比较，计算 SMR[CI]。

结果

共纳入 47 例患者，随访 242 人年。有 16 例（34%）死亡，最常见的死亡原因为急性 ILD 加重和肺炎。MR 为 64.3[39.4-104.9]，50%的患者从 ILD 诊断起 8.3 年内死亡。在调整混杂因素后，（与 NSIP 相比，UIP 与更高的死亡风险相关。总体 SMR 为 2.57[1.4-4.17]。60-75 岁的女性是 SMR 最高的人群。