Centre for Heart Lung Innovation and.
St. Paul's Hospital, Vancouver, British Columbia, Canada.
Am J Respir Crit Care Med. 2024 May 1;209(9):1082-1090. doi: 10.1164/rccm.202307-1275OC.
Particulate matter with an aerodynamic diameter ⩽2.5 μm is associated with adverse outcomes in fibrotic interstitial lung disease (fILD), but the impact of ultrafine particulates (UFPs; aerodynamic diameter ⩽100 nm) remains unknown. To evaluate UFP associations with clinical outcomes in fILD. We conducted a multicenter, prospective cohort study enrolling patients with fILD from the University of Pittsburgh Dorothy P. and Richard P. Simmons Center and the Pulmonary Fibrosis Foundation Patient Registry (PFF-PR). Using a national-scale UFP model, we linked exposures using three approaches in the Simmons cohort (residential address geocoordinates, ZIP code centroid geocoordinates, and ZIP code average) and two in the PFF-PR for which only five-digit ZIP code was available (ZIP code centroid and ZIP code average). We tested UFP associations with transplantation-free survival using multivariable Cox proportional-hazards models, baseline percentage predicted FVC and Dl using multivariable linear regressions, and decline in FVC and Dl using linear mixed models adjusting for age, sex, smoking, race, socioeconomic status, site, particulate matter with an aerodynamic diameter ⩽2.5, and nitrogen dioxide. Annual mean outdoor UFP concentrations for 2017 were estimated for 1,416 Simmons and 1,919 PFF-PR patients. Increased UFP concentration was associated with transplantation-free survival in fully adjusted Simmons residential address models (hazard ratio, 1.08 per 1,000 particles/cm [95% confidence interval, 1.01-1.15]; = 0.02) but not PFF-PR models, which used less precise linkage approaches. Higher UFP exposure was associated with lower baseline FVC and more rapid FVC decline in the Simmons registry. Increased UFP exposure was associated with transplantation-free survival and lung function in the cohort with precise residential location linkage. This work highlights the need for more robust regulatory networks to study the health effects of UFPs nationwide.
直径 ⩽2.5μm 的颗粒物与纤维化间质性肺疾病（fILD）的不良结局相关，但超细微粒（UFPs；直径 ⩽100nm）的影响尚不清楚。为了评估 UFPs 与 fILD 临床结局的关系。我们进行了一项多中心前瞻性队列研究，纳入了来自匹兹堡大学多萝西·P 和理查德·P·西蒙斯中心以及肺纤维化基金会患者登记处（PFF-PR）的 fILD 患者。使用全国性的 UFPs 模型，我们通过三种方法在西蒙斯队列中进行暴露关联（居住地址地理坐标、ZIP 代码中心地理坐标和 ZIP 代码平均值），在 PFF-PR 中进行了两种方法（仅可用五位数字的 ZIP 代码）（ZIP 代码中心和 ZIP 代码平均值）。我们使用多变量 Cox 比例风险模型测试 UFPs 与无移植生存的关系，使用多变量线性回归测试基线预测的 FVC 和 Dl 的百分比，使用线性混合模型测试 FVC 和 Dl 的下降，调整年龄、性别、吸烟、种族、社会经济地位、地点、直径 ⩽2.5μm 的颗粒物和二氧化氮。估计了 2017 年 1416 名西蒙斯和 1919 名 PFF-PR 患者的年度平均户外 UFPs 浓度。在完全调整的西蒙斯居住地址模型中，UFPs 浓度的增加与无移植生存相关（风险比，每增加 1000 个颗粒/cm 1.08[95%置信区间，1.01-1.15]；=0.02），但 PFF-PR 模型不相关，后者使用的关联方法不太精确。在西蒙斯登记处，较高的 UFPs 暴露与较低的基线 FVC 和较快的 FVC 下降相关。在具有精确居住位置关联的队列中，UFPs 暴露的增加与无移植生存和肺功能相关。这项工作强调了需要更强大的监管网络来研究全国范围内 UFPs 的健康影响。
