Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka, Japan.
Department of Medical Statistics, Research and Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Mod Rheumatol. 2023 Aug 25;33(5):928-935. doi: 10.1093/mr/roac115.
The aim of this multi-centre retrospective study was to clarify the prognostic factors for respiratory-related death in patients with interstitial lung disease (ILD) complicated rheumatoid arthritis (RA). Patient background data, treatment regimen, and disease activity indicators of RA and ILD at baseline, 6 months after the diagnosis of ILD, and at the last follow-up visit were extracted. A total of 312 patients with RA-ILD (17 patients who died from respiratory-related causes and 295 survivors) were included. Patients who died from respiratory-related causes had an older median age, a higher proportion of being male, and a higher anti-cyclic citrullinated peptide antibody positivity rate than survivors (p = .0001, .038, and .016, respectively); they also had significantly higher baseline serum levels of Krebs von den Lungen-6 (KL-6) than survivors (p = .013). Patients who died from respiratory-related causes showed significantly greater changes in serum KL-6 levels between the 6-month time point and the last visit [ΔKL-6 (6 months - last)] than survivors (p = .011). Multivariate analysis showed that the ΔKL-6 (6 months - last) corrected by disease duration was a predictor of respiratory-disease-related death in patients with RA-ILD (p < .0001). Long-term increase in serum KL-6 levels is associated with respiratory-disease related death in patients with RA-ILD.
本多中心回顾性研究旨在阐明伴有间质性肺病（ILD）的类风湿关节炎（RA）患者发生与呼吸相关的死亡的预后因素。提取患者背景数据、RA 和ILD 的基线、ILD 诊断后 6 个月和最后一次随访时的治疗方案和疾病活动指标。共纳入 312 例 RA-ILD 患者（17 例死于与呼吸相关的原因，295 例存活者）。死于与呼吸相关的原因的患者的中位年龄更大，男性比例更高，抗环瓜氨酸肽抗体阳性率也高于存活者（p = .0001，p = .038 和 p = .016）；他们的基线血清 Krebs von den Lungen-6（KL-6）水平也显著高于存活者（p = .013）。与存活者相比，死于与呼吸相关的原因的患者在 6 个月时间点与最后一次就诊之间的血清 KL-6 水平变化[ΔKL-6（6 个月-最后）]明显更大（p = .011）。多变量分析显示，由疾病持续时间校正的ΔKL-6（6 个月-最后）是 RA-ILD 患者发生与呼吸疾病相关死亡的预测因素（p < .0001）。血清 KL-6 水平的长期升高与 RA-ILD 患者的与呼吸疾病相关的死亡相关。
