Biblowitz Kathleen, Lee Cathryn, Zhu Daisy, Noth Imre, Vij Rekha, Strek Mary E, Bellam Shashi K, Adegunsoye Ayodeji
Division of Pulmonary and Critical Care, Dept of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Section of Pulmonology and Critical Care Medicine, University of Chicago, Chicago, IL, USA.
ERJ Open Res. 2021 Nov 8;7(4). doi: 10.1183/23120541.00254-2021. eCollection 2021 Oct.
Interstitial lung diseases (ILDs) are diffuse parenchymal lung disorders that cause substantial morbidity and mortality. In patients with ILD, elevated antinuclear antibody (ANA) titres may be a sign of an autoimmune process. Inhalational exposures contribute to ILD pathogenesis and affect prognosis and may trigger autoimmune disease. The association of inhalational exposures with ANA seropositivity in ILD patients is unknown.
This was a retrospective cohort study of adult ILD patients from five centres in the United States. Exposures to tobacco, inhaled organic antigens and inhaled inorganic particles were extracted from medical records. A multivariable logistic regression model was used to analyse the effects of confounders including age, ILD diagnosis, gender and exposure type on ANA seropositivity.
Among 1265 patients with ILD, there were more ANA-seropositive (58.6%, n=741) than ANA-seronegative patients (41.4%, n=524). ANA-seropositive patients had lower total lung capacity (69% 75%, p<0.001) and forced vital capacity (64% 70%, p<0.001) than patients who were ANA-seronegative. Among patients with tobacco exposure, 61.4% (n=449) were ANA-positive compared to 54.7% (n=292) of those without tobacco exposure. In multivariable analysis, tobacco exposure remained independently associated with increased ANA seropositivity (OR 1.38, 95% CI 1.12-1.71). This significant difference was similarly demonstrated among patients with and without a history of inorganic exposures (OR 1.52, 95% CI 1.12-2.07).
Patients with ILD and inhalational exposure had significantly higher prevalence of ANA-seropositivity than those without reported exposures across ILD diagnoses. Environmental and occupational exposures should be systematically reviewed in patients with ILD, particularly those with ANA-seropositivity.
间质性肺疾病（ILDs）是一类导致严重发病和死亡的弥漫性实质性肺疾病。在ILD患者中，抗核抗体（ANA）滴度升高可能是自身免疫过程的一个迹象。吸入性暴露参与ILD的发病机制，影响预后，并可能引发自身免疫性疾病。ILD患者中吸入性暴露与ANA血清阳性之间的关联尚不清楚。
这是一项对来自美国五个中心的成年ILD患者的回顾性队列研究。从病历中提取烟草、吸入性有机抗原和吸入性无机颗粒的暴露情况。使用多变量逻辑回归模型分析包括年龄、ILD诊断、性别和暴露类型等混杂因素对ANA血清阳性的影响。
在1265例ILD患者中，ANA血清阳性患者（58.6%，n = 741）多于ANA血清阴性患者（41.4%，n = 524）。ANA血清阳性患者的总肺容量（69% 75%，p < 0.001）和用力肺活量（64% 70%，p < 0.001）低于ANA血清阴性患者。在有烟草暴露的患者中，61.4%（n = 449）为ANA阳性，而无烟草暴露的患者中这一比例为54.7%（n = 292）。在多变量分析中，烟草暴露仍然与ANA血清阳性增加独立相关（比值比1.38，95%可信区间1.12 - 1.71）。在有和无无机暴露史的患者中也同样显示出这一显著差异（比值比1.52，95%可信区间1.12 - 2.07）。
在所有ILD诊断中，有吸入性暴露的ILD患者ANA血清阳性的患病率显著高于未报告有暴露的患者。对于ILD患者，尤其是ANA血清阳性的患者，应系统地评估环境和职业暴露情况。
