Kluanwan Yanisa, Moua Teng
Division of Pulmonary and Critical Care Medicine, Central Chest Institute of Thailand, Muang, Thailand.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
BMC Pulm Med. 2025 May 10;25(1):229. doi: 10.1186/s12890-025-03703-z.
The role of chronic inflammation in non-idiopathic pulmonary fibrosis fibrotic interstitial lung disease (non-IPF f-ILD) remains unclear, with varied responses to anti-inflammatory or immunosuppressive therapy. A reliable predictor for guiding treatment response may enhance clinical decision-making and minimize adverse treatment effects. We hypothesized that elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may be associated with improved treatment response.
Our retrospective cohort study compared treatment response to anti-inflammatory therapy in patients with non-IPF f-ILD stratified by baseline CRP and ESR levels. Treatment response was defined as: (1) relative increase in percent predicted forced vital capacity (FVC%) ≥ 5% in 6 months or ≥ 10% in 12 months; or (2) no change or any increase in FVC% if FVC% decline was noted prior to treatment. Logistic regression was used to delineate outcome predictors with FVC% change over time assessed with linear mixed effects models.
Of 832 non-IPF f-ILD patients screened, 167 received anti-inflammatory therapy and baseline inflammatory marker testing stratified into high vs. low-to-normal groups (104 vs. 63, respectively). Median age was 64 years, and 57% were diagnosed with a systemic autoimmune rheumatic disease (SARD). Treatment response was greater in those with elevated inflammatory markers (56% vs. 35%; OR 2.45 [1.243-4.828] P = 0.010) even after adjustment for a priori covariables. SARD diagnosis was associated with treatment response (OR 2.90 [1.45-5.81] P = 0.003), independent of inflammatory marker level. A positive FVC% slope was observed in treated patients with initially elevated inflammatory markers (P = 0.003).
Patients with non-IPF f-ILD and elevated inflammatory markers appear to be more responsive to anti-inflammatory therapy with slower FVC decline over time. These findings suggest baseline serum ESR and CRP may be feasible and reliable predictors of treatment response in certain subgroups.
慢性炎症在非特发性肺纤维化的纤维化间质性肺疾病（非IPF f-ILD）中的作用仍不明确，患者对抗炎或免疫抑制治疗的反应各不相同。一个可靠的指导治疗反应的预测指标可能会改善临床决策并将不良治疗效果降至最低。我们假设，C反应蛋白（CRP）和红细胞沉降率（ESR）升高可能与更好的治疗反应相关。
我们的回顾性队列研究比较了根据基线CRP和ESR水平分层的非IPF f-ILD患者对抗炎治疗的反应。治疗反应定义为：（1）预测用力肺活量百分比（FVC%）在6个月内相对增加≥5%或在12个月内≥10%；或（2）如果治疗前FVC%下降，则FVC%无变化或有任何增加。使用逻辑回归来确定结果预测指标，并通过线性混合效应模型评估FVC%随时间的变化。
在832例接受筛查的非IPF f-ILD患者中，167例接受了抗炎治疗，基线炎症标志物检测分为高组与低至正常组（分别为104例和63例）。中位年龄为64岁，57%的患者被诊断为系统性自身免疫性风湿病（SARD）。即使在对先验协变量进行调整后，炎症标志物升高的患者治疗反应更好（56%对35%；OR 2.45 [1.243 - 4.828]，P = 0.010）。SARD诊断与治疗反应相关（OR 2.90 [1.45 - 5.81]，P = 0.003），独立于炎症标志物水平。在最初炎症标志物升高的治疗患者中观察到FVC%呈正斜率（P = 0.003）。
非IPF f-ILD且炎症标志物升高的患者似乎对抗炎治疗反应更好，FVC随时间下降更缓慢。这些发现表明，基线血清ESR和CRP可能是某些亚组中治疗反应的可行且可靠的预测指标。
