Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis
Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis
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DOI：
10.1378/chest.12-2685
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发表时间：
2013-11-01
期刊：
影响因子：
9.6
通讯作者：
Brown, Kevin K.
中科院分区：
文献类型：
--
作者：
Perez, Evans R. Fernandez;Swigris, Jeffrey J.;Brown, Kevin K.
背景：过敏性肺炎(HP)治疗的基础是让患者避免使用激发抗原(IA)。通常情况下，尽管进行了详尽的搜索，仍找不到内务部。本研究的目的是探讨IA对慢性Hp患者生存的影响。方法：采用Kaplan-Meier方法显示慢性Hp患者的生存曲线，用log-ranch检验进行比较。结果：142例患者中，67例(47%)有明确的IA，75例(53%)有不明原因的IA。与幸存者相比，死亡的患者(n=80，56%)年龄更大，更有可能吸烟，预测的总肺活量%和FVC%更低，呼吸困难的严重性更高，更有可能出现肺纤维化，更不可能有可识别的IA。在COX PH模型中，无法识别IA(危险比[HR]，1.76；95%CI，1.01-3.07)、高龄(HR，1.04；95%CI，1.01-1.07)、肺纤维化的存在(HR，2.43；95%CI，1.36-4.35)、低FVC%(HR，1.36；95%CI，1.10-1.68)和吸烟史(HR，2.01；95%C_1，1.15-3.50)是较短生存期的独立预测因素。在调整了平均年龄、纤维化的存在、平均FVC%、肺一氧化碳平均弥散能力(%)和吸烟史后，有明确的IA暴露的患者的生存时间比未确定的IA暴露的患者长(中位数，8.75年对4.88年；P=.047)。结论：在慢性幽门螺杆菌患者中，当调整包括纤维化的存在在内的一些潜在的影响预测因素时，无法识别IA与生存期缩短独立相关。
Background: The cornerstone of hypersensitivity pneumonitis (HP) management is having patients avoid the inciting antigen (IA). Often, despite an exhaustive search, an IA cannot be found. The objective of this study was to examine whether identifying the IA impacts survival in patients with chronic HP.Methods: We used the Kaplan-Meier method to display, and the log-rank test to compare, survival curves of patients with well-characterized chronic HP stratified on identification of an IA exposure. A Cox proportional hazards (PH) model was used to identify independent predictors in time-to-death analysis.Results: Of 142 patients, 67 (47%) had an identified IA, and 75 (53%) had an unidentified IA. Compared with survivors, patients who died (n = 80, 56%) were older, more likely to have smoked, had lower total lung capacity % predicted and FVC % predicted, had higher severity of dyspnea, were more likely to have pulmonary fibrosis, and were less likely to have an identifiable IA. In a Cox PH model, the inability to identify an IA (hazard ratio [HR], 1.76; 95% CI, 1.01-3.07), older age (HR, 1.04; 95% CI, 1.01-1.07), the presences of pulmonary fibrosis (HR, 2.43; 95% CI, 1.36-4.35), a lower FVC% (HR, 1.36; 95% CI, 1.10-1.68), and a history of smoking (HR, 2.01; 95% C1, 1.15-3.50) were independent predictors of shorter survival. After adjusting for mean age, presence of fibrosis, mean FVC%, mean diffusing capacity of the lung for carbon monoxide (%), and history of smoking, survival was longer for patients with an identified IA exposure than those with an unidentified IA exposure (median, 8.75 years vs 4.88 years; P = .047).Conclusions: Among patients with chronic HP, when adjusting for a number of potentially influential predictors, including the presence of fibrosis, the inability to identify an IA was independently associated with shortened survival.