Okamoto Masaki, Fujimoto Kiminori, Chikasue Tomonori, Yanagihara Toyoshi, Tabata Kazuhiro, Zaizen Yoshiaki, Tominaga Masaki, Sumi Akiko, Takeoka Hiroaki, Matsuo Norikazu, Nouno Takashi, Kawaguchi Atsushi, Hoshino Tomoaki
Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-0065, Japan; Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Respir Investig. 2025 Jan;63(1):109-117. doi: 10.1016/j.resinv.2024.12.005. Epub 2024 Dec 16.
The prognostic factors in mild fibrosing interstitial lung disease (FILD) have not been established.
We retrospectively attempted to identify predictive factors of annual progression in mild FILD with gender-age-physiology (GAP) score of 3 or less using logistic regression analysis. Annual FILD progression was defined as meeting any two or more of the following conditions: 1, more than 10% decrease in forced vital capacity (FVC) or 15% decrease in diffusing capacity of the lungs for carbon monoxide (D); 2, worsening of dyspnea; 3, worsening of fibrotic change on CT at 1 year after admission.
Univariate analysis showed that diagnosis of connective tissue disease-associated ILD, CT-definite usual interstitial pneumonia (UIP) pattern, composite physiologic index, FVC, D, lowest SpO and decrease in SpO, and walk distance in the 6-minutes walk test (6MWT), chronic pulmonary emphysema assessment test (CAT) score, and some variables in Short-Form 36 were significantly associated with incidence of annual progression. Multivariate analysis showed that independent predictive factors were diagnosis of idiopathic pulmonary fibrosis (IPF) and fibrotic hypersensitivity pneumonitis (HP), CT-definite UIP pattern, lowest SpO and decrease in SpO in the 6MWT, and CAT score. In logistic regression analysis among 63 patients with non-IPF-ILD, diagnosis with fibrotic HP, lowest SpO and decrease in SpO in the 6MWT, and CAT score were also independent risk factors for annual FILD progression.
Exercise-induced hypoxia, patient-reported outcome, radiological UIP pattern, and diagnosis with fibrotic HP are independent predictors of annual progression in mild FILD.
轻度纤维化间质性肺疾病（FILD）的预后因素尚未明确。
我们采用逻辑回归分析，回顾性地试图确定性别 - 年龄 - 生理学（GAP）评分≤3的轻度FILD患者年度病情进展的预测因素。年度FILD进展定义为符合以下任何两项或更多条件：1. 用力肺活量（FVC）下降超过10%或肺一氧化碳弥散量（D）下降15%；2. 呼吸困难加重；3. 入院后1年CT显示纤维化改变加重。
单因素分析显示，结缔组织病相关间质性肺病的诊断、CT明确的普通型间质性肺炎（UIP）模式、综合生理指数、FVC、D、最低SpO₂以及SpO₂下降、6分钟步行试验（6MWT）中的步行距离、慢性阻塞性肺疾病评估测试（CAT）评分以及简明健康状况调查问卷（SF-36）中的一些变量与年度病情进展发生率显著相关。多因素分析显示，独立预测因素为特发性肺纤维化（IPF）和纤维化性过敏性肺炎（HP）的诊断、CT明确的UIP模式、6MWT中的最低SpO₂以及SpO₂下降和CAT评分。在63例非IPF-ILD患者的逻辑回归分析中，纤维化性HP的诊断、6MWT中的最低SpO₂以及SpO₂下降和CAT评分也是FILD年度病情进展的独立危险因素。
运动诱导的低氧血症、患者报告的结果、放射学UIP模式以及纤维化性HP的诊断是轻度FILD患者年度病情进展的独立预测因素。
