肺纤维化急性加重患者短期内死亡危险因素分析

doi:10.3969/j.issn.1000-8535.2020.05.001

广州医药 ›› 2020, Vol. 51 ›› Issue (5): 1-4.DOI: 10.3969/j.issn.1000-8535.2020.05.001

• 论著 • 下一篇

肺纤维化急性加重患者短期内死亡危险因素分析

赵稳¹, 王延生², 周霞¹, 王小凡¹, 吴德阳¹, 熊淑琪¹, 徐军², 刘明²

1 深圳大学总医院呼吸内科(深圳 518055)
2 广州医科大学附属第一医院呼吸科,呼吸疾病国家重点实验室,广州呼吸健康研究院(广州 510120)

收稿日期:2020-05-20 出版日期:2020-09-20 发布日期:2021-11-28
通讯作者: 刘明,E-mail:mingliu128@hotmail.com
基金资助:
国家自然科学基金(81200050);广东省科学自然基金(2014A030313505);广州科技计划项目(201510 010249);深圳大学总医院科技人才助推计划(SUGH-301)

Risk factors for death in patients with acute exacerbation of pulmonary fibrosis

ZHAO Wen¹, WANG Yansheng², ZHOU Xia¹, WANG Xiaofan¹, WU Deyang¹, XIONG Shuqi¹, XU Jun², LIU Ming²

1 Respiratory Medicine, Shenzhen University General Hospital, Shenzhen 518055,China
2 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China

Received:2020-05-20 Online:2020-09-20 Published:2021-11-28

摘要/Abstract

摘要： 目的探讨特发性肺纤维化(IPF)患者和结缔组织病相关性纤维化间质性肺疾病(CTD-fILD)患者急性加重(AE)的短期内死亡的危险因素。方法回顾性分析2017年10月—2019年9月在深圳大学和广州医科大学附属第一医院住院的25例 AE-CTD-fILD和26例AE-IPF患者临床信息,Kaplan-Merier法对两组患者进行生存分析,Cox回顾分析年龄、性别、吸烟、白细胞总数、C反应蛋白、红细胞沉降率及肿瘤指标在急性加重患者死亡中的作用。结果与AE-CTD-fILD比较,AE-IPF患者组男性比例、年龄、吸烟比例较高,红细胞沉降率较低(24/26 vs 10/25,P<0.001;63.77±9.97 vs 58.00±10.32,P=0.048;16/26 vs 9/25,P=0.02;28.07±29.45 vs 64.35±40.34,P=0.002 );90天内,26例AE-IPF患者11例死亡,25例AE-CTD-fILD患者5例死亡,死亡率无明显差异(42.3% vs 20%,P=0.073);Cox回归分析显示,白细胞计数是AE-IPF和AE-CTD-fILD患者的死亡危险因素(HR=1.305,P=0.001;HR=1.529,P=0.009);CA15-3是AE-IPF患者死亡危险因素(HR=1.015,P=0.005)。结论急性加重IPF和CTD-fILD患者短期内死亡风险相似,白细胞计数及外周CA15-3水平可能是肺纤维化急性加重患者短期内死亡的危险因素。

关键词: 特发性肺纤维化, 结缔组织病相关性纤维化间质性肺疾病, 急性加重, 危险因素

Abstract: Objective To explore the risk factors for acute exacerbation (AE) in patients with idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated with fibrotic interstitial lung disease (CTD-fILD). Methods We retrospectively reviewed 25 patients with AE-CTD-fILD and 26 patients with AE-IPF, and Kaplan-Merier was used to analyze the survival of the two groups of patients. The impact of age,gender, smoking,WBC,CRP,ESR and tumor markers on acute exacerbation death were performed by Cox regression analysis. Results The AE-IPF patients had a higher proportion of men,age and smoking,and a lower ESR compared with AE-CTD-fILD patients(24/26 vs 10/25,P<0.001;63.77±9.97 vs 58.00±10.32,P=0.048;16/26 vs 9/25,P=0.02;28.07±29.45 vs 64.35±40.34,P=0.002 ). 11 cases of 26 patients with AE-IPF and 5 cases of 25 patients with AE-CTD-fILD died within 90 days, Log-rank tests showed patients with CTD-fILD had similar mortality rate compared with IPF patients after AE(42.3% vs 20%,P=0.073). The WBC count was negatively correlated with survival and the independent predictors for patients with AE-IPF and AE-CTD-fILD after adjusting for other clinical variates in Cox regression models(HR=1.305,P=0.001;HR=1.529,P=0.009). CA15-3 may be a risk factor for death of AE-IPF patients(HR=1.015,P=0.005). Conclusion AE-CTD-fILD and AE-IPF were associated with similar poor short-term survival, WBC count and plasma CA15-3 may be the independent survival predictors respectively for patients with acute exacerbation of pulmonary fibrosis in short term.

Key words: Idiopathic pulmonary fibrosis, Connective tissue disease associated with fibrotic interstitial lung disease, Acute exacerbatioin, Risk factor

赵稳, 王延生, 周霞, 王小凡, 吴德阳, 熊淑琪, 徐军, 刘明. 肺纤维化急性加重患者短期内死亡危险因素分析[J]. 广州医药, 2020, 51(5): 1-4.

ZHAO Wen, WANG Yansheng, ZHOU Xia, WANG Xiaofan, WU Deyang, XIONG Shuqi, XU Jun, LIU Ming. Risk factors for death in patients with acute exacerbation of pulmonary fibrosis[J]. Guangzhou Medical Journal, 2020, 51(5): 1-4.

参考文献

[1] RAGHU G, COLLARD H R, EGAN J J, et al. An official ATS/ERS/JRS/ALAT statement: idiopathicpulmonary fibrosis: evidence-based guidelines for diagnosis and management[J]. Am J Respir Crit Care Med,2011,83(6):788-824.
[2] MATHAI S C, DANOFF S K. Management of interstitial lung disease associated with connective tissue disease[J]. BMJ, 2016(352):h6819.
[3] SONG J W, HONG S B, LIM C M, et al. Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome[J]. Eur Respir J,2011,37(2):356-363.
[4] TACHIKAWA R, TOMII K, UEDA H, et al. Clinical features and outcome of acute exacerbation of interstitial pneumonia: collagen vascular diseases-related versus idiopathic[J]. Respiration, 2012,83(1):20-27.
[5] CAO M, SHENG J, QIU X, et al. Acute exacerbations of fibrosing interstitial lung disease associated with connective tissue diseases: a population-based study[J]. BMC Pulm Med, 2019,19(1):215.
[6] COLLARD H R, RYERSON C J, CORTE T J, et al. Acute exacerbation of idiopathic pulmonary fibrosis:An international working group report[J]. Am J Respir Crit Care Med,2016,194(3):265-275.
[7] AL-HAMEED F M, SHARMA S. Outcome of patients admitted to the intensive care unit for acute exacerbation of idiopathic pulmonary fibrosis[J]. Can Respir J, 2004,11(2):117-122.
[8] RYERSON C J, CORTE T J, LEE J S, et al. A standar-dized diagnostic ontology for fibrotic interstitial lung disease. An International Working Group Perspective[J]. Am J Respir Crit Care Med, 2017,196(10):1249-1254.
[9] CHURG A, MÜLLER N L, SILVA C I, et al. Acute exacerbation (acute lung injury of unknown cause) in UIP and other forms of fibrotic interstitial pneumonias[J]. Am J Surg Pathol, 2007,31(2):277-284.
[10] WELLS A U, DENTON C P. Interstitial lung disease in connective tissue disease-mechanisms and management[J]. Nature Rev Rheumatol, 2014,10(12):728-739.
[11] SUZUKI A, KONDOH Y, BROWN K K, et al. Acute exacerbations of fibrotic interstitial lung diseases[J]. Respirology, 2020, 25(5):525-534.
[12] ENOMOTO N, OYAMA Y, ENOMOTO Y, et al. Differences in clinical features of acute exacerbation between connective tissue disease-associated interstitial pneumonia and idiopathic pulmonary fibrosis[J]. Chron Respir Dis, 2019(16):1-8.
[13] USUI Y, KAGA A, SAKAI F, et al. A cohort study of mortality predictors in patients with acute exacerbation of chronic fibrosing interstitial pneumonia[J]. BMJ, 2013,3(7):e002971.
[14] WENG D, CHEN X Q, QIU H, et al. The role of infection in acute exacerbation of idiopathic pulmonary fibrosis[J]. Mediators Inflamm, 2019(2019):1-10.
[15] TOMIOKA H, SAKURAI T, HASHIMOTO K, et al. Acute exacerbation of idiopathic pulmonary fibrosis:role of Chlamydophila pneumoniae infection[J]. Respirol, 2007,12(5):700-706.
[16] WOOTTON S C, KIM D S, KONDOH Y, et al. Viral infection in acute exacerbation of idiopathic pulmonary fibrosis[J]. Am J Respir Crit Care Med, 2011,183(12):1698-702.
[17] SUZUKI A, KIMURA T, KATAOKA K, et al. Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema[J]. Respir Med Case Rep, 2018(23):103-106.
[18] D'ALESSANDRO-GABAZZA C N, KOBAYASHI T, YASUMA T, et al. A Staphylococcus pro-apoptotic peptide induces acute exacerbation of pulmonary fibrosis[J]. Nature commun, 2020,11(1):1539.
[19] HIRAI K, HOMMA T, YAMAGUCHI F, et al. Acute exacerbation of idiopathic pulmonary fibrosis induced by pertussis: the first case report[J]. BMC Pulm Med, 2019,19(1):15.

肺纤维化急性加重患者短期内死亡危险因素分析

Risk factors for death in patients with acute exacerbation of pulmonary fibrosis

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 3

编辑推荐

Metrics

本文评价

[1]	许怡文, 李清初. 糖尿病肾病患者肾功能恶化进展的危险因素[J]. 广州医药, 2021, 52(5): 40-43.
[2]	陈冬妮, 吴维涛, 肖小华, 肖孝勇, 曾鸣, 崔曼丽, 杜新. 老年急性缺血性脑卒中并发肺部感染的危险因素[J]. 广州医药, 2021, 52(3): 28-31.
[3]	罗水妹, 黄颂平, 许白兰, 沈冰寒. 肺癌并发肺栓塞的危险因素及预后分析[J]. 广州医药, 2021, 52(2): 40-45.