Reinhard Janna, Polke Markus, Buschulte Katharina, Eichinger Monika, Heußel Claus Peter, Güttlein Maximilian, Michels-Zetsche Julia D, Wielpütz Mark Oliver, Kahnert Kathrin, Kontogianni Konstantina, Klotz Laura V, Allgäuer Michael, Herth Felix J, Eberhardt Ralf, Kreuter Michael, Trudzinski Franziska C
Department of Pneumology and Critical Care Medicine, Center for Interstitial and Rare Lung Diseases, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Thoraxklinik University of Heidelberg, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany.
Sci Rep. 2025 Apr 5;15(1):11730. doi: 10.1038/s41598-025-94575-0.
There are well-documented differences in idiopathic pulmonary fibrosis (IPF) between sexes. The sex-specific prevalence of interstitial lung disease (ILD) subtypes in patients who require a full diagnostic work-up, including transbronchial cryobiopsy (TCB), after initial multidisciplinary discussion (MDD) is still unknown. Retrospective analysis of sex dispareties in patients with ILD who received an interdisciplinary indication for lung biopsy and underwent bronchoalveolar lavage, TCB and, if necessary, surgical lung biopsy at our ILD centre in Heidelberg between 11/17 and 12/21. The analysis included clinical parameters, visual assessment of computed tomography (CT), automated histogram analyses of lung density by validated software and final MDD-ILD classifications. A total of 402 patients (248 men, 154 women; mean age 68 ± 12 years) were analysed. Smoking behaviour was similar between the sexes, but women were more exposed to environmental factors, whereas men were more exposed to occupational factors. Women had higher rates of thyroid disease (29.9% vs. 12.5%; p < 0.001) and extrathoracic malignancies (16.2% vs. 9.3%; p = 0.041), but lower rates of coronary heart disease (7.1% vs. 19.8%; p < 0.001), stroke (1.3% vs. 6.5%; p = 0.014) and sleep apnoea (5.8% vs. 17.7%; p < 0.001). There were no sex differences regarding CT lung density. On visual inspection, women were less likely to have reticular opacities (65% vs. 76%; p = 0.017) and features of usual interstitial pneumonia (17% vs. 34%; p < 0.001). Among final diagnoses, hypersensitivity pneumonitis was more common in women (34.4%) compared to men (21.8%; p = 0.007). In contrast, IPF was more common in men (22.6%) than in women (7.1%; p < 0.001), and unclassifiable interstitial lung disease was also more frequent in men (21.8%) compared to women (6.5%; p < 0.001). This study highlights significant sex-based differences in the prevalence and characteristics of ILD requiring comprehensive diagnostic work-up. These findings underscore the importance of considering sex-specific factors in the diagnosis and management of ILD.
特发性肺纤维化（IPF）在性别上存在有充分文献记载的差异。在经过初步多学科讨论（MDD）后需要进行全面诊断检查（包括经支气管冷冻活检（TCB））的患者中，间质性肺疾病（ILD）亚型的性别特异性患病率仍然未知。对2017年11月至2021年12月期间在海德堡我们的ILD中心接受肺活检跨学科指征并接受支气管肺泡灌洗、TCB以及必要时进行外科肺活检的ILD患者的性别差异进行回顾性分析。该分析包括临床参数、计算机断层扫描（CT）的视觉评估、通过经过验证的软件对肺密度进行的自动直方图分析以及最终的MDD-ILD分类。总共分析了402名患者（248名男性和154名女性；平均年龄68±12岁）。两性的吸烟行为相似，但女性更多地暴露于环境因素，而男性更多地暴露于职业因素。女性甲状腺疾病的发生率较高（29.9%对12.5%；p<0.001）和胸外恶性肿瘤的发生率较高（16.2%对9.3%；p=0.041），但冠心病的发生率较低（7.1%对19.8%；p<0.001）、中风的发生率较低（1.3%对6.5%；p=0.014）和睡眠呼吸暂停的发生率较低（5.8%对17.7%；p<0.001）。关于CT肺密度没有性别差异。在视觉检查中，女性出现网状阴影的可能性较小（65%对76%；p=0.017）和普通间质性肺炎特征的可能性较小（17%对34%；p<0.001）。在最终诊断中，过敏性肺炎在女性中（34.4%）比在男性中（21.8%；p=0.007）更常见。相比之下，IPF在男性中（22.6%）比在女性中（7.1%；p<0.001）更常见，并且无法分类的间质性肺疾病在男性中（21.8%）也比在女性中（6.5%；p<0.001）更频繁。这项研究强调了在需要全面诊断检查的ILD的患病率和特征方面存在显著的性别差异。这些发现强调了在ILD的诊断和管理中考虑性别特异性因素的重要性。
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