结缔组织病相关间质性肺疾病患者进行性肺纤维化的临床疗效:一项单中心回顾性队列研究。
Clinical effect of progressive pulmonary fibrosis on patients with connective tissue disease-associated interstitial lung disease: a single center retrospective cohort study.
机构信息
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Clin Exp Med. 2023 Dec;23(8):4797-4807. doi: 10.1007/s10238-023-01212-z. Epub 2023 Oct 13.
The concept of progressive pulmonary fibrosis (PPF) has been introduced to predict the diverse prognosis of interstitial lung disease (ILD). However, the incidence and effect of PPF on outcomes in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD) need to be elucidated. This study reviewed 197 patients with CTD-ILD. Symptomatic worsening, pulmonary function decline, and radiological deterioration were investigated to assess the fulfillment of PPF diagnostic criteria. Clinical outcomes, including mortality, were compared based on the presence or absence of PPF. The median follow-up duration was 17.4 months. The mean age of the patients was 64.0 years, and 60.9% were female. Among the underlying CTDs, rheumatoid arthritis (42.1%), inflammatory myositis (19.8%), and systemic sclerosis (13.2%) were the most common. Of the 197 patients, 37 (18.8%) met the diagnostic criteria for PPF during the follow-up period. Even after adjusting for other significant risk factors, PPF was independently associated with mortality [hazard ratio (HR) 3.856; 95% confidence interval (CI) 1.387-10.715; P = 0.010] and baseline albumin was marginally significantly associated with mortality (HR 0.549; CI 0.298-1.010; P = 0.054). The median survival was also significantly shorter in the PPF group than in the non-PPF group (72.3 ± 12.9 vs. 126.8 ± 15.5 months, P < 0.001). Baseline KL-6 ≥ 1000 (U/mL) was a significant risk factor for PPF (HR 2.885; CI 1.165-7.144; P = 0.022). In addition to increased mortality, the PPF group had significantly higher rates of respiratory-related hospitalizations, pneumonia, acute exacerbations, and weight loss than the non-PPF group. PPF is a significant prognostic indicator in patients with CTD-ILD. Thus, healthcare professionals should know that patients with CTD-ILD are at risk of PPF.
进行性肺纤维化(PPF)的概念已被引入,以预测间质性肺疾病(ILD)的不同预后。然而,需要阐明 PPF 在结缔组织病相关间质性肺疾病(CTD-ILD)患者中的发生率和对结局的影响。本研究回顾了 197 例 CTD-ILD 患者。评估症状恶化、肺功能下降和影像学恶化,以评估 PPF 诊断标准的满足情况。根据是否存在 PPF 比较临床结局,包括死亡率。中位随访时间为 17.4 个月。患者的平均年龄为 64.0 岁,60.9%为女性。在基础 CTD 中,类风湿关节炎(42.1%)、炎性肌病(19.8%)和系统性硬化症(13.2%)最为常见。在 197 例患者中,37 例(18.8%)在随访期间符合 PPF 的诊断标准。即使在调整其他重要危险因素后,PPF 与死亡率独立相关[风险比(HR)3.856;95%置信区间(CI)1.387-10.715;P=0.010],基线白蛋白与死亡率也呈边缘显著相关(HR 0.549;CI 0.298-1.010;P=0.054)。PPF 组的中位生存期也明显短于非 PPF 组(72.3±12.9 与 126.8±15.5 个月,P<0.001)。基线 KL-6≥1000(U/mL)是 PPF 的显著危险因素(HR 2.885;CI 1.165-7.144;P=0.022)。除了死亡率增加外,PPF 组的呼吸道住院、肺炎、急性加重和体重减轻发生率明显高于非 PPF 组。PPF 是 CTD-ILD 患者的重要预后指标。因此,医护人员应知道,CTD-ILD 患者存在发生 PPF 的风险。