論文No2433
Predictors of acute exacerbation in biopsy-proven idiopathic pulmonary fibrosis
Tomoo Kishaba, Hironao Hozumi, Tomoyuki Fujisawa, Yuichiro Nei, Noriyuki Enomoto, Hiroaki Sugiura, Masashi Kitani, Takafumi Suda
Respiratory Investigation, Volume 58, Issue 3, May 2020, Pages 177-184
＜背景＞
急性増悪(AE)は特発性肺線維症(IPF)患者の主な死亡原因である。
現在のAE-IPFのエビデンスは多くは病理学的というよりも臨床的な解析に基づいている。
＜方法＞
多専門科議論(MDD)によってIPFと診断された患者の
臨床、放射線、病理学的データを使用してAEの頻度、その予測因子を検討した。
この研究は以前の研究の二次解析で、外科的肺生検(SLB)を行った155名のIPF患者を含んでいる。
累積AE頻度はカプランマイヤー法で評価した。
AE-IPFの予測因子はFine-Gray部分分布ハザードモデルで解析した。
サブ解析は傾向スコアマッチ解析で行った。
＜結果＞
このコホートで、患者中央値は66歳で%FVC中央値は82%であった。
SLB後30日時点、１年後の累積AE頻度は1.9%, 7.6%であった。
多変量解析で、%DLCOが低い(hazard ratio 0.98 per 1% increase, P = 0.02)、
線維芽巣(FF)がある(vs. absent; hazard ratio 3.01, P = 0.04)は、
AEが起こりやすい独立した予測因子であった。
傾向スコアマッチ解析で年齢、性別、%DLCOを補正して行うと、
累積AE頻度はFFあり群の方がなし群よりも有意に高かった
(1-year incidence rate, 10.5% vs. 0%, respectively; P = 0.04 by Gray's test)。
＜感想＞
生検で確定診断したIPFにおいて、線維芽巣がある、%DLCOが低い、は急性増悪の独立した予測因子だったようです。
Background
Acute exacerbation (AE) is a major cause of death in patients with idiopathic pulmonary fibrosis (IPF). Current evidence on AE-IPF has been largely based on clinical, rather than pathological, analyses.
Methods
We investigated AE incidence and its predictors using clinical, radiological, and pathological data of patients diagnosed with IPF by multi-disciplinary discussion.
This study, a secondary analysis of previous research, included 155 patients with IPF who underwent surgical lung biopsy (SLB). Cumulative AE incidence was evaluated by the Kaplan–Meier method. Predictors of AE-IPF were analyzed with a Fine-Gray sub-distribution hazard model. Sub-analysis was performed using propensity score-matching analysis.
Results
In this cohort, the median age of the patients was 66 years and the median percent-predicted forced vital capacity was 82.8%. The cumulative AE incidence rates at 30 days and one year post SLB were 1.9% and 7.6%, respectively. On multivariable analysis, a lower percent-predicted diffusing capacity of the lung for carbon monoxide (%DLCO) (hazard ratio 0.98 per 1% increase, P = 0.02) and fibroblastic foci (FF)-present (vs. absent; hazard ratio 3.01, P = 0.04) were independently associated with a higher incidence of AE. The propensity score-matching analysis with adjustment for age, gender, and %DLCO revealed that the cumulative AE incidence rate was significantly higher in the FF-present subgroup than in the FF-absent subgroup (1-year incidence rate, 10.5% vs. 0%, respectively; P = 0.04 by Gray's test).
Conclusions
FF and %DLCO were independent predictors of AE in patients with biopsy-proven IPF. FF may be associated with the pathogenesis of AE-IPF.