Wang Yuanying, Guo Ziyun, Ma Ruimin, Wang Jingwei, Wu Na, Fan Yali, Ye Qiao
Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Occupational Medicine and Toxicology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Front Pharmacol. 2022 Jul 1;13:924754. doi: 10.3389/fphar.2022.924754. eCollection 2022.
Limited data are available regarding the entire spectrum of interstitial lung disease with a progressive fibrosing feature. We investigated the prevalence and prognostic predictive characteristics in patients with PF-ILD. This retrospective cohort study included patients with fibrosing ILD who were investigated between 1 January 2015 and 30 April 2021. We recorded clinical features and outcomes to identify the possible risk factors for fibrosing progression as well as mortality. Of the 579 patients with fibrosing ILD, 227 (39.21%) met the criteria for progression. Clubbing of fingers [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.03 to 2.24, = 0.035] and a high-resolution computed tomography (HRCT)-documented usual interstitial pneumonia (UIP)-like fibrotic pattern (OR 1.95, 95% CI 1.33 to 2.86, = 0.001) were risk factors for fibrosis progression. The mortality was worse in patients with PF with hypoxemia [hazard ratio (HR) 2.08, 95% CI 1.31 to 3.32, = 0.002], in those with baseline diffusion capacity of the lung for carbon monoxide (DLCO) % predicted <50% (HR 2.25, 95% CI 1.45 to 3.50, < 0.001), or in those with UIP-like fibrotic pattern (HR 1.68, 95% CI 1.04 to 2.71, < 0.001). Clubbing of fingers and an HRCT-documented UIP-like fibrotic pattern were more likely to be associated with progressive fibrosing with varied prevalence based on the specific diagnosis. Among patients with progressive fibrosing, those with hypoxemia, lower baseline DLCO% predicted, or UIP-like fibrotic pattern showed poor mortality.
关于具有进行性纤维化特征的间质性肺疾病的全貌,现有数据有限。我们调查了PF-ILD患者的患病率和预后预测特征。这项回顾性队列研究纳入了2015年1月1日至2021年4月30日期间接受调查的纤维化ILD患者。我们记录了临床特征和结局,以确定纤维化进展以及死亡的可能危险因素。在579例纤维化ILD患者中,227例(39.21%)符合进展标准。手指杵状指[比值比(OR)1.52,95%置信区间(CI)1.03至2.24,P = 0.035]和高分辨率计算机断层扫描(HRCT)记录的普通型间质性肺炎(UIP)样纤维化模式(OR 1.95,95%CI 1.33至2.86,P = 0.001)是纤维化进展的危险因素。低氧血症的PF患者死亡率更高[风险比(HR)2.08,95%CI 1.31至3.32,P = 0.002],基线肺一氧化碳弥散量(DLCO)%预测值<50%的患者(HR 2.25,95%CI 1.45至3.50,P < 0.001),或具有UIP样纤维化模式的患者(HR 1.68,95%CI 1.04至2.71,P < 0.001)。手指杵状指和HRCT记录的UIP样纤维化模式更有可能与基于特定诊断的不同患病率的进行性纤维化相关。在进行性纤维化患者中,低氧血症、较低的基线DLCO%预测值或UIP样纤维化模式的患者死亡率较差。