Lee Cathryn T, Gandhi Sheiphali A, Elmrayed Seham, Barnes Hayley, Lorenzetti Diane, Salisbury Margaret L, Stewart Iain D, Barber Christopher, Peters Cheryl E, Feary Johanna, Johannson Kerri A
Department of Medicine, The University of Chicago, Chicago, Illinois, USA
Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Thorax. 2025 Jun 15. doi: 10.1136/thorax-2024-222306.
Inhalational exposures are associated with risk of developing interstitial lung disease (ILD), yet the relationship between specific exposures and ILD is poorly characterised.
Identify inhalational exposures associated with ILD and estimate the effects of exposures on ILD risk.
MEDLINE and EMBASE databases were searched from 1990 to 2022 to identify inhalational exposures associated with ILD diagnosis. ILDs where causality is well-established (hypersensitivity pneumonitis, pneumoconiosis) and sarcoidosis were excluded. Two independent reviewers screened abstracts with full-text review and data extraction of eligible studies. Where possible, data were pooled and multilevel meta-analysis was specified using a random effects model. Sources of heterogeneity and risk of bias were assessed.
96 studies were included in the systematic review, representing 40 819 116 subjects (295 167 had ILD, 40 523 949 controls). For the meta-analysis, 54 studies were included (40 490 793 subjects: 273 899 ILD, 40 216 894 controls). Exposures associated with significantly increased ILD risk included smoking (OR 1.69, 95% CI 1.47 to 1.94), organic exposures (OR 1.56, 95% CI 1.12 to 2.16), metals (OR 1.52, 95% CI 1.07 to 2.16), dust (OR 1.45, 95% CI 1.20 to 1.76) and asbestos (OR 1.53, 95% CI 1.08 to 2.15). Silica and fumes had positive associations with ILD that trended towards significance.
This systematic review and multilevel meta-analysis is the first to comprehensively assess the effect of inhalational exposures on overall risk of ILD, with multiple putative exposures identified. Future work should investigate novel occupational exposures associated with ILD, characterise the gene-environment interaction and develop preventative strategies.
CRD42022292908.
吸入性暴露与间质性肺疾病（ILD）的发生风险相关，但特定暴露与ILD之间的关系仍未得到充分描述。
确定与ILD相关的吸入性暴露，并评估暴露对ILD风险的影响。
检索1990年至2022年的MEDLINE和EMBASE数据库，以确定与ILD诊断相关的吸入性暴露。因果关系明确的ILD（过敏性肺炎、尘肺病）和结节病被排除。两名独立评审员筛选摘要，并进行全文审查和对符合条件的研究进行数据提取。在可能的情况下，汇总数据并使用随机效应模型进行多水平荟萃分析。评估异质性来源和偏倚风险。
系统评价纳入了96项研究，代表40819116名受试者（295167人患有ILD，40523949人为对照）。荟萃分析纳入了54项研究（40490793名受试者：273899人患有ILD，40216894人为对照）。与ILD风险显著增加相关的暴露包括吸烟（比值比1.69，95%置信区间1.47至1.94）、有机暴露（比值比1.56，95%置信区间1.12至2.16）、金属（比值比1.52，95%置信区间1.07至2.16）、粉尘（比值比1.45，95%置信区间1.20至1.76）和石棉（比值比1.53，95%置信区间1.08至2.15）。二氧化硅和烟雾与ILD呈正相关，且有显著趋势。
这项系统评价和多水平荟萃分析首次全面评估了吸入性暴露对ILD总体风险的影响，并确定了多种可能的暴露因素。未来的工作应调查与ILD相关的新型职业暴露，描述基因-环境相互作用，并制定预防策略。
PROSPERO注册号：CRD42022292908。
