Arai Toru, Hirose Masaki, Hatsuda Kazuyoshi, Kagawa Tomoko
Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Osaka, Japan.
J Thorac Dis. 2025 Apr 30;17(4):2038-2049. doi: 10.21037/jtd-2024-2142. Epub 2025 Apr 28.
Idiopathic pulmonary fibrosis (IPF) is an idiopathic fibrotic interstitial lung disease with poor prognosis. Recently, the prognostic value of serum platelet-derived growth factor (PDGF) levels in patients with IPF has been clarified. Monocyte counts in the peripheral blood have also been reported to be an important predictor of survival in IPF. This study aimed to clarify the prognostic value of serum immunoglobulin (Ig) A levels in patients with IPF to predict survival and occurrence of acute exacerbations (AE).
This retrospective study included 71 patients diagnosed with IPF based on the 2022 guidelines. Serum PDGF and interleukin (IL)-10 levels were measured using the Bio-Plex method. IgA levels were measured by a clinical testing company.
Of the enrolled patients, 59 were male, and the median age of the sample was 67 [interquartile range (IQR): 61-72] years. The median serum IgA level was 307 (IQR: 232-408) mg/dL and 18 patients had serum IgA levels of >400 mg/dL. Univariate Cox proportional hazard regression analysis revealed that high IgA levels (>400 mg/dL) were a significant predictor of poor prognosis; however, monocyte counts were not. A high IgA level was a significant prognostic factor after adjusting for the percent predicted value of forced vital capacity, age, gender, and body mass index. Serum PDGF levels tended to be higher in patients with high IgA levels than in those with low IgA levels. IL-10 was not significantly correlated with IgA levels; however, IgA levels tended to be negatively correlated with monocyte counts. High IgA levels did not significantly predict AE. High monocyte counts (>600/µL) significantly predicted the early incidence of AE by univariate Cox analysis but was not confirmed by multivariate analysis. However, monocyte counts, and a monocyte count of >600/µL were significant predictors of AE occurrence for patients with low IgA ≤400 mg/dL.
The serum IgA level is an independent prognostic predictor of survival in patients with IPF. Serum IgA levels might suggest serum fibrogenic cytokine levels. Serum IgA levels might be associated with prognosis differently from peripheral monocyte counts. The pathophysiological role of IgA needs to be elucidated in future studies.
特发性肺纤维化(IPF)是一种预后较差的特发性纤维化间质性肺疾病。最近,IPF患者血清血小板衍生生长因子(PDGF)水平的预后价值已得到明确。外周血单核细胞计数也被报道是IPF患者生存的重要预测指标。本研究旨在阐明血清免疫球蛋白(Ig)A水平对IPF患者预测生存及急性加重(AE)发生的预后价值。
这项回顾性研究纳入了71例根据2022年指南诊断为IPF的患者。采用Bio-Plex方法检测血清PDGF和白细胞介素(IL)-10水平。IgA水平由一家临床检测公司测定。
在纳入的患者中,59例为男性,样本的中位年龄为67岁[四分位间距(IQR):61 - 72岁]。血清IgA中位水平为307(IQR:232 - 408)mg/dL,18例患者血清IgA水平>400 mg/dL。单因素Cox比例风险回归分析显示,高IgA水平(>400 mg/dL)是预后不良的显著预测指标;然而,单核细胞计数并非如此。在校正了用力肺活量预测值百分比、年龄、性别和体重指数后,高IgA水平是一个显著的预后因素。高IgA水平患者的血清PDGF水平往往高于低IgA水平患者。IL-10与IgA水平无显著相关性;然而,IgA水平往往与单核细胞计数呈负相关。高IgA水平并不能显著预测AE。单因素Cox分析显示,高单核细胞计数(>600/µL)显著预测AE的早期发生,但多因素分析未证实这一点。然而,对于IgA≤400 mg/dL的低IgA水平患者,单核细胞计数以及单核细胞计数>600/µL是AE发生的显著预测指标。
血清IgA水平是IPF患者生存的独立预后预测指标。血清IgA水平可能提示血清促纤维化细胞因子水平。血清IgA水平与外周单核细胞计数对预后的影响可能不同。IgA的病理生理作用有待未来研究阐明。