Ibarra-Fernández Alan Aldair, Robles-Hernández Robinson, Orea-Tejeda Arturo, González-Islas Dulce, Jiménez-Valentín Angelia, Sánchez-Santillán Rocío, Arcos-Pacheco Laura Patricia, Gutiérrez-Luna Emilio, Zurita-Sandoval Andrea, Peña-Espinosa Tomas, Gutiérrez-Vargas Rosaura, Flores-Cisneros Laura
Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico.
Department of Research in Tobacco Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico.
Respirology. 2025 May;30(5):424-434. doi: 10.1111/resp.14892. Epub 2025 Feb 4.
Fibrotic interstitial lung disease (ILD) is associated with high morbidity and mortality. Patients often exhibit impaired nutritional status and alterations in body composition, such as dynapenia and sarcopenia, which correlate with poor pulmonary function, reduced exercise tolerance and diminished quality of life. However, the impact of dynapenia and sarcopenia on prognosis has not been examined extensively in ILD patients. We assessed the impact of dynapenia and sarcopenia as risk factors for mortality and their prevalence in ILD.
Prospective cohort study. ILD was classified into idiopathic pulmonary fibrosis (IPF), connective tissue disease-related ILD (CTD-ILD) and chronic hypersensitivity pneumonitis (CHP). Patients over 18 years old with a confirmed diagnosis of ILD were included, while those with diagnoses of cancer, human immunodeficiency virus and neurological disease were excluded. Dynapenia and sarcopenia were determined according to EWGSOP2 criteria.
Ninety-eight ILD patients were included; 33.66% had IPF, 47.96% had CTD-ILD, and 18.37% had CHP. The mean age was 63.89 ± 12.02 years; 37.76% were male. The risk factors associated with mortality included dynapenia (HR: 2.04, 95% CI: 1.10-3.77, p = 0.022), sarcopenia (HR: 1.88, 95% CI; 1.00-3.33, p = 0.049) and exercise tolerance (HR: 0.99, 95% CI; 0.99-0.99, p = 0.023), adjusted for confounding variables. The prevalence of dynapenia was 45% in ILD; 51% in IPF, 35% in CTD-ILD and 61% in CHP. The prevalence of sarcopenia was 29%; both IPF (39%) and CHP (50%) had a higher prevalence of sarcopenia than CTD-ILD (14%).
Sarcopenia and dynapenia are independent risk factors for mortality in ILD.
纤维化间质性肺疾病（ILD）与高发病率和死亡率相关。患者常表现出营养状况受损和身体成分改变，如肌无力和肌肉减少症，这与肺功能差、运动耐力降低及生活质量下降相关。然而，肌无力和肌肉减少症对ILD患者预后的影响尚未得到广泛研究。我们评估了肌无力和肌肉减少症作为ILD患者死亡风险因素的影响及其患病率。
前瞻性队列研究。ILD分为特发性肺纤维化（IPF）、结缔组织病相关ILD（CTD-ILD）和慢性过敏性肺炎（CHP）。纳入确诊为ILD的18岁以上患者，排除患有癌症、人类免疫缺陷病毒和神经系统疾病的患者。根据EWGSOP2标准确定肌无力和肌肉减少症。
纳入98例ILD患者；33.66%患有IPF，47.96%患有CTD-ILD，18.37%患有CHP。平均年龄为63.89±12.02岁；37.76%为男性。调整混杂变量后，与死亡相关的风险因素包括肌无力（HR：2.04，95%CI：1.10-3.77，p = 0.022）、肌肉减少症（HR：1.88，95%CI；1.00-3.33，p = 0.用调整后的混杂变量分析。ILD患者中肌无力的患病率为45%；IPF中为51%，CTD-ILD中为35%，CHP中为61%。肌肉减少症的患病率为29%；IPF（39%）和CHP（50%）的肌肉减少症患病率均高于CTD-ILD（14%）。
肌肉减少症和肌无力是ILD患者死亡的独立风险因素。
